Risk factors for Anal Fissures

• Risk factors in the development of anal fissures include chronic constipation, passage of hard and/or large stools, straining during defecation, and prolonged diarrhea.

• Diets low in fiber and water may increase the risk of straining during defecation and constipation and thus may increase the risk of anal fissure development.

• Diets high in agents that may increase the risk of constipation, including caffeine, may increase the risk of straining during defecation and of constipation and thus may increase the risk of anal fissure development. Spicy foods may aggravate symptoms of anal fissures.

• Aging is a risk factor for anal fissures. Aging is often accompanied by decreased blood flow to the anus, increasing the risk of nonhealing wounds.

• The potassium-channel activator nicorandil may increase the risk of anal fissure. Use of this agent is associated with increased anal ulcerations. However, the available research is limited.

• Pregnancy and childbirth may increase the risk of anal fissures. In pregnancy, up to one-third of women develop anal fissures and external hemorrhoids. Constipation and dyschezia (retaining stool in the rectum) during pregnancy may be the main risk factors during pregnancy.

• In infants, risk factors include infrequent diaper changes and constipation, often due to inadequate fluid intake. Infants with a previous episode of abscess or pus at the time of surgery were more likely to have recurring anal fissures. Early introduction of cow's milk may increase constipation and therefore the risk of anal fissures.

• Other risk factors in adults include harsh anal hygiene (rough toilet paper), chronic wetness around the anus, rectal irritation, bariatric procedures for obesity, constant saddle vibration (in professional mountain bikers), the use of bidet toilets, sexual abuse, and inflammatory bowel disorders such as Crohn's disease.

from here

Note:  Other risk factors in adults include chronic wetness around the anus.  What about sitz baths and all the hot compresses I've been using to alleviate the pain?  The more pain I have, the wetter I've been keeping my anus--is that making things worse?