Anal Fissure Epidemiology Forecast 2025-2034

Anal fissures may occur across all age groups; however, they are most commonly observed in children and middle-aged individuals. Each year, an estimated 250,000 new cases are reported in The United States, with the condition affecting males and females equally.

Anal Fissure Epidemiology Forecast Report Coverage

The Anal Fissure Epidemiology Forecast Report 2025-2034 delivers a comprehensive analysis of the condition’s prevalence and associated demographic factors. It projects future incidence and prevalence trends across diverse population groups, considering key variables such as age, gender, and anal fissure type. The report highlights changes in prevalence over time and offers data-driven forecasts based on influencing factors. Additionally, it provides an in-depth overview of the disease, along with historical and projected epidemiological data for eight key markets:

The United States, United Kingdom, France, Italy, Spain, Germany, Japan, and India.

Anal Fissure:

Disease Overview

An anal fissure is a small tear or crack in the lining of the anal canal, often caused by the passage of hard or large stools, prolonged diarrhoea, or constipation. This condition typically leads to pain, bleeding, and discomfort during or after bowel movements. Anal fissures can be acute or chronic, with chronic cases lasting more than six weeks. While they can affect individuals of any age, they are most commonly seen in infants and middle-aged adults. Treatment ranges from dietary changes and topical medications to surgical interventions in persistent cases.

Epidemiology Overview

The epidemiology section on anal fissures provides a comprehensive view of the patient population from historical data to present trends, along with projections across the eight major markets. The Research evaluates extensive studies to deliver current and forecasted insights into anal fissure cases. The report segments the diagnosed population by age groups and other demographic factors for detailed analysis.

• Around 10%-15% of cases occur at the anterior midline of the anus, while 85%-90% are found posteriorly, with some having fissures in both areas.
• Research indicates that anal fissures occur equally in men and women and may arise at any age, although they are most frequently reported in children and middle-aged individuals.
• Nearly 40% of those diagnosed with anal fissures go on to develop chronic symptoms.
• The condition is especially common among pregnant individuals and infants, and about half of those diagnosed experience symptoms before turning 40.

Anal Fissure:

Treatment Overview

Anal fissure treatment aims to reduce pain, promote healing, and prevent recurrence. Initial management typically includes conservative therapies such as dietary adjustments, sitz baths, and topical medications. If fissures persist, pharmacological and surgical interventions may be required. Chronic fissures often necessitate a tailored combination of therapies. The choice of treatment depends on fissure severity, chronicity, and patient response to initial therapy.

1. Topical Nitroglycerin Ointment

Topical nitroglycerin is commonly prescribed to relax the anal sphincter, thereby increasing blood flow and promoting healing. It works by reducing resting pressure in the internal anal sphincter, easing pain and allowing the fissure to close. Applied directly to the fissure area, this treatment often relieves symptoms within weeks. However, it may cause side effects such as headaches or local irritation. It is especially useful in patients with chronic fissures who do not respond to dietary and hygiene changes.

2. Calcium Channel Blockers (Topical Diltiazem or Nifedipine)

Topical calcium channel blockers like diltiazem or nifedipine are used to relax the smooth muscle of the anal sphincter. These medications improve blood flow and reduce sphincter pressure, aiding in the healing of chronic fissures. They are often chosen when nitroglycerin is not tolerated. This treatment has fewer side effects than nitroglycerin and is applied locally to the fissure twice daily. Some patients experience mild itching or irritation, but it is generally well tolerated and effective for long-term use.

3. Botox Injections

Botulinum toxin (Botox) is injected directly into the anal sphincter muscle to induce temporary paralysis, reducing muscle spasms and pressure. This helps to ease pain and promote fissure healing, particularly in chronic cases. Botox treatment is minimally invasive and typically performed under local anaesthesia. The effects last for about 2-3 months, during which the fissure may heal. While effective, there’s a small risk of transient incontinence and recurrence, so it is considered when topical treatments fail.

4. Lateral Internal Sphincterotomy

Lateral internal sphincterotomy is a surgical procedure that involves cutting a small portion of the internal anal sphincter to reduce pressure and facilitate healing. It is considered the gold standard for chronic, non-healing anal fissures. The surgery has a high success rate, with most patients experiencing permanent relief. It is typically reserved for cases unresponsive to medical therapy. While effective, risks include minor bleeding and a small chance of faecal incontinence, which is usually temporary.

5. Dietary and Lifestyle Modifications

Conservative treatment includes increasing dietary fibre intake, drinking plenty of fluids, and using stool softeners to prevent constipation and reduce straining during bowel movements. Sitz baths (warm water baths for the buttocks) can help soothe the affected area and relax the anal sphincter. This approach is typically the first line of management for acute fissures and is crucial in preventing recurrence. These measures are safe, inexpensive, and can be highly effective when followed consistently.

Anal Fissure:

Burden Analysis

Anal fissures impose a notable burden on patients' daily lives due to persistent pain, discomfort during bowel movements, and fear of recurrence. The condition often leads to anxiety, embarrassment, and social withdrawal, especially in chronic cases. Sleep disturbances, dietary restrictions, and altered bowel habits further diminish quality of life. In severe or untreated cases, fissures may lead to complications such as infections or abscesses. The psychological impact, coupled with the physical discomfort, contributes to reduced productivity and emotional distress, emphasising the importance of early diagnosis and appropriate treatment to alleviate long-term consequences.

Key Epidemiology Trends

Anal fissure, a painful linear tear in the skin of the anal canal, continues to exhibit dynamic epidemiological trends influenced by lifestyle, age, and healthcare accessibility. Its chronic and recurrent nature also affects both the physical comfort and quality of life of individuals. Based on current patterns, five notable epidemiological trends in the context of anal fissure are outlined below:

1. Lifestyle Changes Driving Constipation-Related Cases

An emerging trend in anal fissure epidemiology is the increasing number of cases linked to lifestyle-induced constipation. Sedentary behaviour, irregular dietary patterns, and insufficient fluid intake are contributing significantly to the onset of anal fissure. These changes have been particularly observed in urban populations and office-based workers, where physical inactivity correlates with poor gastrointestinal health. The rise in fast food consumption and processed diets low in fibre also contributes to hard stools, which heighten the risk of tearing the anal lining during defecation.

2. Anal Fissure in Women Following Childbirth

A significant number of anal fissure cases are being reported among postpartum women. During vaginal delivery, excessive pressure on the pelvic floor and anal canal can result in tearing or straining, leading to the development of anal fissure. Hormonal fluctuations and iron supplements, which often cause constipation, further contribute to this risk. This trend has been increasingly identified in maternal health records, prompting healthcare providers to advocate for postnatal bowel management and early interventions to prevent chronic fissure formation.

3. Increasing Recognition in Paediatric Patients

Anal fissure has been historically underdiagnosed in children due to symptom overlap with other gastrointestinal issues. However, current epidemiological assessments show a notable rise in diagnosis among infants and toddlers. Contributing factors include dietary transitions, such as the introduction of solid foods, and frequent constipation in early childhood. The pain associated with bowel movements often leads to withholding behaviour, worsening the condition. Increased awareness among paediatricians has led to earlier diagnosis and better outcomes in this demographic.

4. Chronic Anal Fissure in the Elderly

With advancing age, gastrointestinal motility often slows down, and chronic constipation becomes more prevalent. This results in a higher incidence of anal fissure among the elderly, particularly those with limited mobility or poor access to dietary fibre. Additionally, coexisting medical conditions and medication-induced constipation further increase susceptibility. This age-related trend calls for specialised geriatric interventions that include tailored bowel regimens and awareness among caregivers regarding symptoms and treatment options.

5. Geographic and Socioeconomic Disparities in Prevalence

Anal fissure shows considerable variation in incidence across regions due to differences in diet, sanitation, and healthcare access. In areas with high rates of poverty or limited health infrastructure, individuals are more likely to experience untreated constipation, leading to chronic fissures. Conversely, in developed countries with greater healthcare reach, early diagnosis and non-invasive treatments are reducing the chronic burden of this condition. Dietary customs, particularly low fibre consumption in certain populations, have also been linked to higher regional prevalence.

Analysis By Region

The epidemiology of anal fissure varies across countries and regions due to differences in healthcare infrastructure, socioeconomic factors, cultural attitudes towards pain, and access to pain management therapies. Understanding these variations is essential for developing targeted interventions and improving patient outcomes.

Key regions include:

• The United States
• Germany
• France
• Italy
• Spain
• The United Kingdom
• Japan
• India

These regions exhibit distinct epidemiological trends, reflecting the unique challenges and opportunities within their healthcare systems.

The epidemiological patterns of anal fissures differ widely across countries, influenced by factors such as dietary fibre consumption, rates of constipation, access to medical care, cultural openness about anorectal health, economic status, and overall health behaviours. In The United States alone, an estimated 250,000 people receive a diagnosis of anal fissures annually.

Key Questions Answered

• What demographic groups show the highest prevalence of anal fissures across different geographic regions?
• How do dietary patterns and fibre intake influence the global incidence of anal fissures?
• What role does healthcare accessibility play in the diagnosis and treatment of anal fissures in low-income regions?
• Are there identifiable genetic predispositions that contribute to a higher risk of developing anal fissures?
• What is the recurrence rate of anal fissures post-treatment across various populations?
• How does the prevalence of chronic constipation correlate with rising anal fissure cases globally?
• What are the trends in anal fissure diagnosis among pediatric versus adult populations?
• How do cultural attitudes impact the reporting and early detection of anal fissures in different countries?
• What proportion of anal fissure cases progress to chronic forms, and how does this vary by region?
• How have advancements in non-invasive diagnostic tools influenced detection rates of anal fissures worldwide?

Scope of the Report

• The report covers a detailed analysis of signs and symptoms, causes, risk factors, pathophysiology, diagnosis, treatment options, and classification/types of anal fissure based on several factors.
• The anal fissure epidemiology forecast report covers data for the eight major markets (the US, France, Germany, Italy, Spain, the UK, Japan, and India)
• The report helps to identify the patient population, the unmet needs of anal fissure are highlighted along with an assessment of the disease's risk and burden.