Anal fissures are tears in the anal canal skin, usually produced by constipation.
Acute fissures cause severe sudden pain and bleeding with bowel movements, and usually resolve with analgesics and stool softeners. Chronic fissures cause pain with all bowel movements. Patients develop a fear of defecation and become more constipated, making the fissure worse. Treatments of chronic fissures include nitroglycerine cream, diltiazem cream, botox, and surgery.