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Fissure-in-ano is a linear tear or ulceration in the anoderm, typically located in the posterior midline of the anal canal. It is commonly caused by trauma from passage of hard stools, chronic constipation, prolonged diarrhea, or excessive straining during defecation. The tear leads to exposure of the internal anal sphincter fibers, resulting in severe pain and reflex sphincter spasm, which further compromises blood flow and delays healing.

Patients usually present with intense, sharp anal pain during and after bowel movements, often accompanied by streaks of bright red bleeding on stool or toilet paper. Chronic fissures may develop a sentinel pile (skin tag) and hypertrophied anal papilla. Persistent sphincter spasm contributes to recurrent symptoms and non-healing ulcers.

Diagnosis is primarily clinical, based on history and gentle inspection of the anal region. Digital rectal examination may be limited due to pain. It is important to differentiate fissures from other anorectal conditions, such as Hemorrhoids or inflammatory disorders.

Management initially involves conservative therapy, including high-fiber diet, adequate hydration, stool softeners, and topical vasodilators (e.g., nitroglycerin or calcium channel blockers). Refractory cases may require lateral internal sphincterotomy, which effectively reduces sphincter pressure and promotes healing.