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Causes of recurring anal rectal fissures

A patient presents with severe anal pain, lasting hours after each bowel movement. She notices some intermittent bleeding with defecation. She comes to the office with the presumed diagnosis of hemorrhoids. Are her symptoms consistent with hemorrhoidal disease, or does she have another disorder? Benign anorectal disorders are common and increasing in incidence.
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Anal Fissure: A Common Cause of Anal Pain

Causes of recurring anal rectal fissures
Causes of recurring anal rectal fissures
Causes of recurring anal rectal fissures
Causes of recurring anal rectal fissures
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Anal Fissure: Symptoms, Causes, Diagnosis, and Treatment

An anal fissure is a small cut or tear in the lining of the anus. The crack in the skin causes severe pain and some bright red bleeding during and after bowel movements. At times, the fissure can be deep enough to expose the muscle tissue underneath. In most cases, the tear heals on its own within four to six weeks. Certain treatments can promote healing and help relieve discomfort, including stool softeners and topical pain relievers. Or your doctor may need to look for other underlying disorders that can cause anal fissures. An anal fissure most often occurs when passing large or hard stools.
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Chronic anal fissure: 2% topical diltiazem hydrochloride

An anal fissure is a common and often painful problem caused by a small tear or ulcer open sore in the lining of the anus back passage. This can cause bleeding, local itching and pain with a bowel movement, which can be severe. When someone has an anal fissure the first treatments can include a high-fibre diet, laxatives and applying anaesthetic ointments to the affected area. Anal fissures usually heal within a few weeks but those that have not healed after 4—6 weeks are called chronic fissures. If someone has a chronic fissure, it is thought that the reason it has not healed is that the ring muscle sphincter that goes around the anus back passage has become so tense that the flow of blood to the lining of the anus is reduced.
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An anal fissure fissure-in-ano is a small, oval shaped tear in skin that lines the opening of the anus. Fissures typically cause severe pain and bleeding with bowel movements. Fissures are quite common in the general population, but are often confused with other causes of pain and bleeding, such as hemorrhoids.
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