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Anal Fissure: Symptoms, Causes, and Treatment Options

An anal fissure is a small tear in the lining of the anal canal that causes sharp pain and sometimes bleeding during or just after a bowel movement. Most anal fissures heal within weeks with conservative care — stool softeners, sitz baths, and topical treatments. A specialist is needed when self-care is insufficient.

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What is an anal fissure?

The anal canal is lined with delicate tissue. When that lining tears — usually from passing a hard or large stool — the result is an anal fissure. The tear exposes the underlying internal sphincter muscle, which can go into spasm, reducing blood flow and making it harder for the tissue to heal on its own 1.

Fissures are classified as acute (less than about six weeks old) or chronic (persisting beyond six weeks). Chronic fissures often develop a sentinel skin tag at one end and a hypertrophied anal papilla at the other — signs visible to a clinician during examination.

What does an anal fissure feel like?

The most common symptom is sharp, tearing pain during a bowel movement, sometimes described as passing broken glass. The pain can linger for minutes to hours afterward as the sphincter muscle remains in spasm.

Other symptoms include: - A small amount of bright red blood on toilet paper or in the bowl (separate from stool) - Itching or burning around the anus - A visible crack or small skin tag near the anal opening 1

Not everyone notices bleeding. Pain alone is often the presenting complaint.

How is an anal fissure different from a hemorrhoid?

Both cause rectal discomfort and bleeding, but they differ in important ways 1.

| Feature | Anal fissure | Hemorrhoid | |---|---|---| | Pain quality | Sharp, often severe during and after bowel movement | Dull pressure or no pain (internal); aching or tenderness if thrombosed | | Bleeding | Bright red, on paper or bowl, not mixed with stool | Bright red, similar pattern | | Location | Linear tear in anal canal lining | Swollen vascular tissue inside or just outside the canal | | Visible finding | Crack or tear | Bulge or lump |

A clinician can distinguish the two with a brief visual examination. Because treatment differs, getting an accurate diagnosis matters — Gale can connect you with a gastroenterologist or colorectal surgeon.

What causes anal fissures?

The most common causes are: - Constipation and hard stools — straining stretches the anal lining beyond its limit - Diarrhea — frequent liquid stools can also irritate and tear the tissue - Childbirth — delivery can cause posterior anal tears - Low-fiber diet — bulkier stools are paradoxically gentler on the canal 2

Less commonly, fissures can be associated with inflammatory bowel disease (Crohn's disease in particular), sexually transmitted infections, or prior anal surgery. Fissures in unusual locations — off the midline — or those that do not respond to standard treatment should be evaluated for an underlying cause 1.

How are anal fissures treated?

Conservative (first-line) measures resolve most acute fissures:

  • Increase dietary fiber and fluid intake to soften stools 2
  • Sitz baths — soaking the area in warm water for 10–20 minutes after bowel movements relaxes the sphincter and improves blood flow
  • Stool softeners if constipation is contributing
  • Topical anesthetics (over-the-counter) for pain relief

Topical medications prescribed by a clinician include nitrates (glyceryl trinitrate) or calcium channel blockers (diltiazem), which relax the internal sphincter and allow the fissure to heal. These are considered first-line pharmacologic options by major gastroenterology guidelines 1.

Botulinum toxin injection into the sphincter is an outpatient option when topical therapy fails. It temporarily relaxes the muscle, improving blood flow to the tear.

Lateral internal sphincterotomy is a minor surgical procedure with high healing rates but carries a small risk of incontinence. It is reserved for chronic fissures that have not responded to other treatments 1.

Healing time with conservative care is typically two to four weeks for acute fissures.

When should I see a specialist?

See a gastroenterologist or colorectal surgeon if: - Pain or bleeding has not improved after a few weeks of self-care - You are not sure whether you have a fissure or a hemorrhoid - You notice blood mixed in with your stool (rather than on the surface) — this warrants prompt evaluation - You have a history of inflammatory bowel disease or a fissure in an unusual location 1

Clinicians typically diagnose anal fissures on examination; additional tests such as anoscopy or colonoscopy may be recommended to rule out other conditions, particularly if you are over 50 or have other GI symptoms 1.

Gale can help you find a gastroenterologist, understand what to expect at the visit, and prepare questions to bring.

Common questions

Can an anal fissure heal on its own?

Many acute fissures do heal on their own when stool is kept soft and the area is kept clean with warm soaks. Chronic fissures — those lasting more than about six weeks — are much less likely to resolve without medical treatment.

Is it safe to use hemorrhoid creams on a fissure?

Over-the-counter hemorrhoid creams containing a topical anesthetic may ease discomfort, but they are not specifically formulated to heal a fissure. A clinician can prescribe topical treatments that act directly on the sphincter muscle, which is more effective for fissures.

Will I need surgery?

Most people do not need surgery. Topical medications and sitz baths resolve the majority of fissures. Surgery (lateral internal sphincterotomy) is considered only for chronic fissures that have not responded to multiple courses of medical treatment.

How do I prevent anal fissures from coming back?

A high-fiber diet, adequate hydration, and avoiding prolonged straining on the toilet are the most effective preventive measures. Treating constipation promptly — rather than letting it become chronic — makes recurrence much less likely.

Talk to a clinician

Gale can match you with a licensed clinician for a visit.

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When to seek prompt care

  • —Blood mixed into the stool (not just on the surface) — may indicate a source higher in the GI tract
  • —Significant rectal bleeding — soaking through tissue or dripping into the bowl
  • —Fever, severe pain, or swelling around the anal area — may suggest infection or abscess
  • —Symptoms that do not improve at all after two to four weeks of conservative care

If you have heavy rectal bleeding that does not stop, go to an emergency room or call 911.

This article provides general health information only and does not replace a personal evaluation by a clinician. Gale can connect you with a gastroenterologist or colorectal surgeon for diagnosis and treatment.

References

  1. 1.Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, Zutshi M (2021). ACG Clinical Guidelines: Management of Benign Anorectal Disorders. American Journal of Gastroenterology. doi:10.14309/ajg.0000000000001507 ✓Diagnosis, classification, topical pharmacologic, and surgical treatment options for anal fissures; differentiation from hemorrhoids
  2. 2.National Institute of Diabetes and Digestive and Kidney Diseases (2023). Eating, Diet, & Nutrition for Constipation. NIDDK. link ✓Dietary fiber and fluid intake as first-line measures to soften stools and prevent constipation-related anal injuries

2 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.