It is a rupture or tear in the inner lining of the anus, usually in the middle and back.
There are many triggers, such as passing large hard stools through the anal canal, prolonged diarrhoea, labour, inflammatory bowel disease and infectious diseases (syphilis, tuberculosis). In childhood, the most common cause is constipation caused by the passage of hard stools that damage the anal mucosa.
It manifests as severe anal pain that increases during bowel movements and may be accompanied by blood, which typically stains the toilet paper after bowel movements. Sometimes it can also be associated with anal itching and mucus or yellowish mucus staining.
It is diagnosed clinically by questioning and examining the area.
Most cases heal with conservative treatment: avoid constipation and hard stools by eating fibre-rich foods and keeping properly hydrated. Other medications used: laxatives, creamy local anaesthetics, petroleum jelly or hydrocortisone and zinc oxide combinations. Surgical repair may be required in severe cases.
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