In anal fissure – colloquially called anal fissure – (Latin fissura: fissure, crack; synonyms: Anal fissure; Anal fissure; Acute anal fissure; Anal rhagade; Chronic anal fissure; Fissura ani; Fistula in ano; Nontraumatic and nonpuerperal anus laceration; Nontraumatic anal fissure; Rectal fissure; Rectal rhagade; ICD-10-GM K60. 0: Acute anal fissure; ICD-10-GM K60.1: Chronic anal fissure; ICD-10-GM K60.2: Anal fissure, unspecified) is a radial tear of the skin or mucosa in the anal canal (anoderm) distal to the linea dentata.
At the linea dentata, the squamous epithelium of the anal canal meets the epithelium of the rectum, which lies in the oral (” directed toward the mouth“) direction.
A distinction is made between primary and secondary anal fissures. Primary anal fissures are not caused by an underlying disease. Secondary anal fissures, on the other hand, are caused by a wide variety of diseases (e.g. Crohn’s disease) as well as by trauma or after anal surgery. See more on this under the topic “Causes”.
Furthermore, the acute form can be distinguished from the chronic form. In the chronic form, the symptoms persist for longer than 6 to 8 weeks.
Sex ratio: Men and women are affected with equal frequency.
Frequency peak: The disease occurs predominantly between the 30th and 50th year of life.
The prevalence (disease frequency) is 10% (in Germany) in proctological (suffering from intestinal diseases) patients. Based on studies with circumscribed patient collectives, a lifetime risk of up to 8 % is indicated.
Course and prognosis: Acute anal fissure is painful and is most noticeable during defecation. The quality of life of the affected person suffers. With adequate therapy, the disease takes a good course, i.e. 60-90% of acute anal fissures heal without consequences. The healing process takes between 6 and 8 weeks. A chronic anal fissure heals only in approx. 50 % of cases under conservative therapy. A chronic course is manifested by hypertrophic anal papillae (distal mucosal extensions of the anal columns), outpost fold or sentinel mariske (perianal/around the anus localized, flaccid skin folds) distal to the fissure, and ulceration (ulcer), among other symptoms.If a fistula forms, surgical intervention becomes necessary (first-line therapy).
