An ESCP Guide for Patients
View our short printable guide
What is an anal fissure?
An anal fissure is a small cut or tear in the skin around the opening of the anus. It can cause sharp pain, especially during or after a bowel movement. You may also notice bright red blood on toilet paper or mild mucus discharge.
Fissures are common and can affect anyone, regardless of age or gender. They’re often mistaken for haemorrhoids because the symptoms can be similar. In most cases (90%), fissures appear at the back side of the anus. In some cases (10%), they can appear at the front.
Acute vs chronic fissures
- Acute fissures (less than 3 weeks) often heal on their own with simple changes
- Chronic fissures (more than 8 weeks) may need medical or surgical treatment
Common causes of an anal fissure
The exact origin of an anal fissure can be difficult to determine, but anal fissures are usually caused by injury or pressure to the anal area. Common causes include:
- Constipation: straining or passing hard stools can create small tears
- Muscle tension: tight anal muscles (sphincter spasms) reduce blood flow and slow healing
- Inflammatory bowel conditions: such as Crohn’s disease
- Pregnancy and childbirth: increased pressure can lead to fissures
Symptoms of an anal fissure
- Sharp or burning pain during and after bowel movements
- Bright red blood on the stool or toilet paper
- Itching or irritation near the anus
- A visible tear or crack near the anus
- Muscle spasms or tightness in the anal area
How is an anal fissure diagnosed?
Doctors usually diagnose anal fissures based on symptoms and a physical examination. Additional tests, such as a rectoscopy, are generally avoided during an active fissure because they may cause more discomfort.
Treatment options for an anal fissure
Most anal fissures heal without surgery. Treatment aims to reduce pain, improve blood flow, promote healing and prevent further injury.
Lifestyle and diet changes
Making changes to your daily routine can help heal the fissure and prevent recurrence. These small daily habits can help:
- Eat more fibre: fruits, vegetables and whole grains help soften stools
- Drink plenty of water: stay well hydrated
- Use stool softeners or mild laxatives: these make bowel movements easier
- Exercise regularly: encourages bowel movement and reduces constipation
- Practice good toilet habits: avoid straining and don’t sit for too long; use a small bench to elevate the feet to correct your posture
Medical treatment
Your doctor may prescribe:
- Topical anesthetics (e.g. lidocaine): to relieve pain
- Topical vasodilators (e.g. diltiazem, nitrate ointments): to improve blood flow and promote healing
- Fibre supplements or mild laxatives: to ensure soft and regular bowel movements
- Pelvic floor therapy: if tight pelvic muscles are contributing to the fissure
Surgical treatments
If other treatments do not work, more invasive options may be needed:
- Botox injection: helps relax the anal sphincter, improving blood flow
- Lateral internal sphincterotomy: a minor surgery where part of the sphincter muscle is cut to reduce tension and allow healing
Each treatment has its risks and benefits. Your doctor will discuss these with you to determine the best option.
When to see a doctor
Consult your doctor if you have:
- Ongoing pain after bowel movements
- Bleeding or discharge
- Symptoms lasting longer than 2-3 weeks
Early treatment improves healing and reduces the risk of chronic fissures.
If you have questions or concerns, don’t hesitate to talk with your doctor or colorectal surgeon.
Disclaimer
The information provided here is general and hopes to correctly inform the patient to the extent possible. However, this document cannot discuss all aspects of a specific condition or procedure, or of the individual patient.
The decision on which procedure will give you the best result is made by your doctor or colorectal surgeon during consultation and based on shared and informed decision-making with the patient.