Fissures - split or tear in the lining of last tiny bit of the anal canal, sometimes caused by constipation - may cause bleeding which drips into the toilet bowl. Nearly always associated with severe pain when going to the toilet. Can be itchy, especially in women.

What to do

Fissures are mostly treated by special creams which relax the muscles, or injections with Botox. Most people don’t need surgery but, if they do, it’s a very simple operation. Unfortunately it can leave some people, especially women, with leakage problems (mucus, even small amounts of stool.) In over 90 per cent of patients, the operation is excellent, has few complications and is a permanent cure