Is it an anal fissure (AF)?
Appearance:1,2
- Anal mucosa tear from the dentate line to the anal verge, usually in the posterior midline
Symptoms:1,3
- Intense, sharp pain during defecation; pain that persists after defecation
- If bleeding: bright red, usually low volume
Causes:1
- Trauma (e.g., constipation, diarrhea, etc.), ischemia or elevated anal pressure
Acute AF4,5
(<6 weeks’ duration)
- Appears like a fresh, longitudinal laceration
- Heals with local management
Chronic AF1,4,5
(≥6 weeks’ duration)
- Sentinel pile at distal end of fissure is common
- Feels rough, raised or fibrotic in mid-distal anal canal
Download
Anal Fissures: A Quick Guide to Diagnosis and Treatment
to help determine if your patient has an AF
AF is more than a pain in the backside.
A prospective, longitudinal study of AF patients at diagnosis revealed:6*
92%
had pain upon defecation
Patients reported moderate distress and interference of daily activities due to pain, on average
Significant sleep difficulties (mean PSQI† score was
7.6
[± 3.6])6,7
70.6%
had depressive symptoms (39% were mild)
66.7%
had symptoms of anxiety (31% were mild)
AF patients had a 31% increased risk of depression vs. controls, according to a retrospective study
(HR: 1.31 [95% CI: 1.25, 1.38])8‡
The effect of Seaford AF Cream on pain is discussed elsewhere on this website. The effects of Seaford AF Cream on distress due to pain, sleep quality, depression and anxiety have not been evaluated as predefined endpoints in prospectively designed, well-controlled, randomized trials.
AF=anal fissure; CI=confidence interval; HR=hazard ratio; PSQI=Pittsburgh Sleep Quality Index.
*
A prospective, longitudinal study to evaluate psychological parameters and sleep quality among 51 patients aged >18 years with chronic anal fissures visiting colorectal surgery clinics, conducted between October 2020 and February 2021.
†
The global PSQI score ranges from 0 to 21 with higher scores indicate poorer sleep quality. A score greater than 5 suggests significant sleep difficulties.
‡
A retrospective cohort study that utilized data from the Disease Analyzer database (IQVIA) to investigate the incidence of depression in 15,467 patients aged ≥18 years with an initial diagnosis of anal fissure or anorectal fistula.
References:
- Foxx-Orenstein AE, Umar SB, Crowell MD. Common anorectal disorders. Gastroenterol Hepatol. 2014;10(5):294-301.
- Cohee MW, Hurff A, Gazewood JD. Benign anorectal conditions: evaluation and management. Am Fam Physician. 2020;101(1):24-33.
- Gallo G, Trompetto M. Clinical evidence and rationale of topical nifedipine and lidocaine ointment in the treatment of anal fissure and hemorrhoidal disease. Minerva Surg. 2025;80(2):177-192.
- Gerbasi L, Ashurst JV. Anal Fissures. StatPearls. Updated September 15, 2025. Accessed November 6, 2025. https://www.ncbi.nlm.nih.gov/books/NBK526063/?utm_source=chatgpt.com
- Dykstra MA, Buie WD. Anal fissures. CMAJ. 2019;191:E737. doi: 10.1503/cmaj.190074.
- El Muhtaseb MS, et al. Depression and anxiety among chronic anal fissure patients. Int J Surg Open. 2022;46:100518. doi:10.1016/j.ijso.2022.100518.
- University of Pittsburgh. The Pittsburgh Sleep Quality Index (PSQI). University of Pittsburgh website. Accessed December 15, 2025. https://www.sleep.pitt.edu/psqi.
- Krieg A, et al. Depression in patients with anorectal fistulas and anal fissures: a propensity score-matched cohort study. Qual Life Res. 2025;34:701-709.
- Seaford Nifedipine and Lidocaine Hydrochloride Cream. Seaford Pharmaceuticals Inc. June 13, 2025.