An anal fissure is a tear or crack in the lining of the anus. An anal fistula is an abnormal passage like a tube. One opening is in the anal canal and the other usually in the skin near the anus. A fissure may be caused by:
* passage of large stools,
* strain of childbirth,
* diarrhea, or
* insertion of an object.

A long-term form of fissure is a type of ulcer formed by scarring from a local infection. Fissures are extremely painful. Pain is often most severe during bowel movements. They can cause painful spasms of the muscles around the anus. One may notice spots of bright red blood in the stool. There is often a hemorrhoid-like thickening of the mucous membrane at the lower end of the fissure. The fear of pain during a bowel movement can cause constipation. Fissures usually clear if bowel movements are kept regular and soft. Stool softeners such as bran or psyllium seed preparations can help. Suppositories are used if these measures do not work. Anesthetic ointment or solutions that arrest bleeding often help. Warm sitz baths for 15 minutes after each bowel movement will give some relief. In extreme cases when these measures fail, the fissure is repaired surgically.

Most fistulas start from small pouches called crypts. Symptoms of a fistula are:
* foul-smelling discharge,
* local itching,
* tenderness, and
* pain aggravated by bowel movements.

An abscess is an infection in a cavity. They often are seen before fistulas develop. The healthcare provider must rule out other diseases, such as intestinal inflammatory disorders or tuberculosis. The provider may need to look at the fistula by X-ray, insertion of a probe, or with a colonoscope. The only effective treatment is surgery. The fistula is removed while the patient is under anesthesia. If the fistula passes deep into the surrounding muscles, the patient may temporarily lose control of bowel movements after surgery.

The best prevention for tears or infections near the anus is to maintain bowel regularity through natural means. Eat dietary fiber, drink plenty of water, and get regular exercise.

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