Anal Disorders:

What are anal disorders?

The anus is a muscular canal through which stool passes out of the body.  In adults, the anus is about approximately one and a half inches long, and has a lining that contains blood vessels, sensitive nerve endings, and small anal glands. Common anal disorders include:

• Anal fissure:  An anal fissure, also known as an anorectal fissure, is a linear crack or tear in the skin of the anus.  Most anal fissures happen when a large, hard stool overstretches the anal opening and tears the anal skin.  Sometimes, anal fissures develop because of prolonged diarrhea, inflammatory bowel disease or sexually transmitted diseases.  Short-term anal fissures are usually fairly superficial and shallow, but Long-term anal fissures may extend deeper through the anal skin and expose the underlying muscle.
• Anal abscess:  An anal abscess is a small and very painful pocket of pus near the anus.  Most anal abscesses are not related to other health problems and will arise spontaneously, when bacteria or intestinal debris contaminate an anal gland.  Currently in the United States, more than half of all anal abscesses occur in young adults between the ages of 20 and 40, and men are affected more frequently than women.  Most anal abscesses are located near the opening of the anus but they may also occur deeper inside the anal canal.
• Anal fistula:  An anal fistula is an abnormal, narrow, tunnel-like passageway that connects the remains of an old anal abscess to the surface of the skin. Anal fistulas develop in about half of all anal abscesses that have drained.  Sometimes, the opening of the fistula at the skin surface leaks a thick, foul-smelling liquid that has traveled from the depths of the old abscess.  In other cases, the opening of the fistula eventually becomes plugged with draining debris, causing the old anal abscess to flare up again as a firm pocket of pus.
•  Anal stricture:  An anal stricture is a tight band of scar tissue that constricts the anal opening, interfering with the ability to pass stool easily.  Anal strictures can be caused by radiation treatment for cancers located near the anal area, some sexually transmitted diseases, direct trauma to the anus and, sometimes surgery to remove hemorrhoids.

What are the symptoms of anal disorders?

Although all four anal disorders cause some type of anal discomfort or pain, other symptoms may occur, depending on the specific anal problem. 

For anal fissure, symptoms may include:

• Pain in the anal area
• Mild rectal bleeding
• Anal itch

For anal abscess, symptoms include:

• A firm, tender mass or swelling in the anal area
• Throbbing pain near the anus that may worsen with walking
• Fever, chills and a generally sick feeling
• Pain in the lower abdomen

For an anal fistula, signs and symptoms may include:

• Pain or discomfort around the anus
• Persistent drainage of blood, pus or foul-smelling mucus from the anal area
• Symptoms of anal abscess

 For an anal stricture, symptoms include:

• Discomfort or pain during bowel movements

Treatment options:

A physician will be able to diagnose an anal disorder.  Once the diagnosis is made, a treatment may or may not involve surgery, depending on the specific disorder.  

• Anal fissure:  For short term fissurea, a doctor may recommend a stool softener for relieving constipation.  He or she also may recommend a medicated cream.  For long term fissures, surgery can correct the problem in more than 90 percent of cases.
• Anal abscess:  An anal abscess must be opened by a doctor in order to drain the pus. This procedure is called incision and drainage, or I&D.  This usually can be done as an outpatient procedure.
• Anal fistula:  A doctor usually can remove an anal fistula in a surgical procedure called a fistulotomy, which also scrapes away any remnants of the old anal abscess.
• Anal stricture:  For an anal stricture, a physician may recommend a stool softener or fiber supplement to help ease bowel movements past the narrowed anal opening.  If the stricture is more severe, the doctor may treat the problem either by carefully stretching the anal opening with a special instrument, or by surgically cutting through the scar tissue.

Related information:

• Functions of the bowel
• American Gastroenterological Association
• American College of Gastroenterology
• More anal & rectal disorders
• More patient resources

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