Understanding Anal Fissures: Causes, Symptoms and When to See a Doctor

Anal fissures are small tears in the skin around the anus, which can cause sharp pain during bowel movements. In many cases, the pain may continue even after passing stool. Some people also notice a burning sensation or light bleeding. The tear itself is minor, but the discomfort can be intense, making everyday tasks such as sitting or passing stool highly uncomfortable. Over time, fear of pain may lead to avoiding bowel movements all together, which results in constipation and makes the fissure worse. To help understand the condition better, this blog explores the common causes of anal fissures, the symptoms to be aware of, and the point at which medical intervention becomes necessary. Let us start with the basics. 

What is an Anal Fissure?

An anal fissure is a small but painful tear in the skin that lines the anal canal. This area is rich in nerve endings, which makes even minor injuries particularly sensitive. Most fissures develop in the posterior midline of the anus, where blood flow is slightly lower, making healing slower in some cases.

There are two main types of anal fissures: acute and chronic. Acute fissures are recent tears that often heal within a few weeks with basic care. Chronic fissures, on the other hand, last for more than six weeks and may develop a visible skin tag or small lump near the tear, known as a sentinel pile. These longer-lasting fissures may also involve muscle spasm in the anal sphincter, which further restricts blood flow and delays healing.

What Causes an Anal Fissure?

An anal fissure develops when the skin at the opening of the anus tears, often as a result of excessive stretching or irritation. This area has a thin, delicate lining that can break easily under pressure. In most cases, the tear forms during a bowel movement, but the underlying anal fissure causes vary and may involve:

Passing Hard or Large Stools

This is one of the most common triggers. When stool becomes dry or bulky, it puts pressure on the anal opening as it passes through. This can stretch the skin beyond its normal limit, leading to a tear. The risk is higher when bowel movements are infrequent or when passing stool is particularly difficult.

Chronic Constipation

Long-term constipation places repeated strain on the anal muscles. Straining during bowel movements can weaken the tissue over time, making it more prone to tearing. Constipation can also reduce blood flow to the area, which delays healing and increases the chance of fissures becoming long-lasting.

Frequent Diarrhoea

Although often overlooked, ongoing diarrhoea can also cause or worsen fissures. Repeated bowel movements, especially those that are loose or acidic, may irritate the skin. Constant wiping can further damage the area, preventing small tears from healing properly.

Childbirth-Related Trauma

The pressure placed on the anal area during childbirth can sometimes lead to a fissure. This may happen during labour or develop in the days or weeks after delivery. Women who have prolonged labour or deliver larger babies may be at higher risk.

Tight Anal Sphincter Muscles

In some cases, the internal anal muscles are naturally tense or may tighten further in response to pain. This muscle spasm can reduce blood supply to the area, slowing down the healing process. The tightness also increases the likelihood of the tear reopening with each bowel movement.

Direct Trauma to the Anal Area

Tears can also develop from minor injuries, such as forceful wiping, use of rectal thermometers or suppositories, or other forms of local irritation. These may not cause damage on their own, but in sensitive or already inflamed skin, even slight trauma can result in a fissure.

Underlying Medical Conditions

Fissures that do not heal or keep coming back may point to an underlying issue. Conditions such as Crohn’s disease, inflammatory bowel disease, or infections like tuberculosis and HIV can affect the skin around the anus. Poor blood circulation, often seen in elderly or those with vascular problems, can also make healing slower.

What are the Symptoms of an Anal Fissure?

Anal fissures symptoms are usually hard to miss, especially during or after bowel movements. The pain and discomfort tend to be sharp and noticeable, but the condition can also produce other signs that may be mistaken for piles or other rectal problems. Common symptoms include:

• Sharp pain during bowel movements: This is often described as a cutting or tearing sensation and is usually most intense while passing stool.
• Pain that lingers after passing stool: The discomfort may continue for several minutes or even hours after a bowel movement, depending on the severity of the tear.
• Bright red blood on toilet paper or stool: Small amounts of bleeding are common and usually appear as streaks of fresh blood.
• Burning or itching sensation: Some people feel irritation around the anus, especially after cleaning or wiping.
• Visible crack or tear in the anal area: In some cases, a small split in the skin can be seen during a physical examination or with a mirror.
• A small lump near the tear: Chronic fissures may be accompanied by a skin tag or swollen area, often referred to as a sentinel pile.

Symptoms usually begin suddenly and may become worse if the fissure fails to heal properly. If the pain increases or does not improve within a few weeks, it may suggest a chronic fissure that requires medical attention.

What Treatment Options are Available for Anal Fissures?

The approach to treating anal fissures depends on how long the tear has been present, how severe the symptoms are, and how the body is responding to basic care. In many cases, early or mild fissures heal without medical procedures. For chronic or recurring fissures, however, more active treatment may be required to relieve pain and promote proper healing.

Lifestyle and Home-Based Measures

For most acute fissures (those present for less than six weeks), small adjustments in daily habits can reduce discomfort and allow the skin to heal:

• Increasing dietary fibre: A fibre-rich diet helps keep stool soft and easier to pass. This reduces the need for straining and lowers the risk of further tearing. Sources include fruits, vegetables, whole grains, and legumes.
• Drinking enough fluids: Staying hydrated supports smoother digestion and prevents hard stools. Water is usually the best option.
• Using warm sitz baths: Soaking the anal area in warm water for 10–15 minutes several times a day, especially after bowel movements, helps relax the muscles, improve blood flow, and ease discomfort.
• Avoiding constipation triggers: Reducing intake of caffeine and processed foods, and maintaining regular toilet habits, can help prevent further irritation.
• Gentle cleaning: After bowel movements, using unscented moist wipes or lukewarm water instead of dry toilet paper reduces friction on the sensitive skin.

When followed consistently, these measures are often enough for the fissure to close and for symptoms to ease within a few weeks.

Medical Management

If symptoms do not improve with home care or if the fissure is particularly painful, medication may be advised:

• Topical treatments: Ointments containing muscle relaxants or agents that increase blood flow are often prescribed. These help reduce spasm in the anal sphincter and encourage healing
• Pain relief: Local anaesthetic creams may provide temporary pain control. Oral pain relievers or anti-inflammatory drugs may also be used as needed
• Stool softeners or laxatives: These help ensure that bowel movements are gentle on the healing tissue, preventing new tears.

Medical treatment is usually continued for several weeks and monitored for signs of healing.

Non-Surgical Procedures

When a fissure becomes chronic or does not respond to medications, non-surgical methods may be considered to relieve muscle tension and improve healing:

• Botulinum toxin (Botox) injection: A small dose of Botox may be injected into the anal sphincter muscle to temporarily weaken it. This reduces pressure in the area, improves blood flow, and supports closure of the fissure. Results typically last for a few months, giving the tissue time to heal.
• Topical chemical relaxants: In some cases, stronger prescription creams may be used for a longer duration under medical supervision.

These treatments are often suitable for people who are not ready for surgery or who wish to try conservative options first.

Surgical Treatment

Surgery is usually reserved for fissures that have not healed after several months of medical and non-surgical treatment. The most widely used procedure is lateral internal sphincterotomy (LIS). In this procedure, a small part of the internal anal sphincter muscle is carefully cut to reduce tension and improve blood supply. This allows the fissure to heal more effectively. LIS is generally considered safe and has a high success rate, though all surgical procedures carry some risks.

Tips to Prevent Anal Fissures

Anal fissures often result from habits that strain the anal area. Making small adjustments to the daily routine can go a long way in preventing them, especially in those who are prone to constipation or have had fissures before.

• Maintain a high-fibre diet: Include plenty of fruits, vegetables, whole grains, and pulses in daily meals. This helps in forming soft, bulky stool that passes easily without causing strain.
• Drink enough fluids: Aim to stay well hydrated throughout the day, as water helps keep stools soft and supports healthy digestion.
• Avoid straining during bowel movements: Do not delay going to the toilet when the urge arises. Forcing stool out or sitting for too long increases pressure on the anal area.
• Establish regular bowel habits: Try to pass stool at the same time each day, preferably after meals. This creates a predictable routine and reduces the risk of constipation.
• Practise gentle cleaning: After using the toilet, clean the area gently with soft, unscented wipes or lukewarm water. Avoid harsh rubbing, which can irritate the skin.
• Exercise regularly: Physical activity helps stimulate bowel movements and supports overall gut health, lowering the chances of constipation.
• Manage diarrhoea promptly: Chronic diarrhoea can be just as damaging as constipation. Treating underlying digestive issues helps prevent irritation to the anal lining.

When Should You See a Doctor?

In many cases, anal fissures heal on their own with home care. However, medical attention becomes important when symptoms persist or begin to affect daily life. Delaying treatment may lead to complications, especially if the fissure becomes chronic.

Consider seeking medical advice in the following situations:

• Pain does not improve after a week or two, even with dietary changes, warm baths, and stool softeners
• Bleeding continues with every bowel movement or occurs in large amounts.
• Symptoms return frequently, suggesting the fissure may not be healing fully or may be becoming chronic.
• Severe discomfort interferes with activities such as sitting, walking, or passing stool.
• Visible skin changes such as a lump, persistent swelling, or discharge from the anus develop.
• Underlying conditions are suspected, such as inflammatory bowel disease, infection, or poor circulation, especially in individuals with repeated or non-healing fissures.
• Home remedies cause no relief, or side effects from over-the-counter creams and laxatives begin to appear.

Consult Today

Persistent or worsening symptoms of an anal fissure often suggest that healing is delayed or that an underlying issue may be contributing to the problem. In such cases, self-care or home remedies alone may not be enough. A timely medical review helps rule out other conditions, especially if the fissure has become chronic, keeps coming back, or is not responding to basic treatment. At Max Hospital, gastroenterologists take a detailed approach, examining not only the fissure but also any underlying factors that may be delaying recovery. If the condition has become recurrent or difficult to manage, consulting a specialist can help guide effective treatment and prevent future episodes.

Frequently Asked Questions

Can an anal fissure heal on its own without medical help?

Yes, small or early-stage anal fissures often heal on their own with home care, such as a high-fibre diet, proper hydration, and warm sitz baths. However, if symptoms last more than a few weeks or keep coming back, medical advice is recommended to prevent the fissure from becoming chronic.

How can I tell the difference between an anal fissure and haemorrhoids?

Both conditions can cause discomfort and bleeding, but fissures typically cause sharp pain during or after a bowel movement, often described as a cutting or tearing sensation. Haemorrhoids, on the other hand, usually cause a dull ache, itching, or a feeling of fullness in the rectal area. A physical examination is often needed to confirm the diagnosis.

Is it normal to bleed every time I pass stool if I have a fissure?

Small amounts of bright red blood on toilet paper or in the toilet bowl can occur with fissures, especially during bowel movements. However, frequent or heavy bleeding should not be ignored, as it may signal a more serious condition and should be reviewed by a doctor.

Do over-the-counter creams help with anal fissures?

Some over-the-counter products can help reduce discomfort by numbing the area or softening the skin, but they do not treat the underlying cause. Long-term use without guidance may delay healing or irritate the skin further. If pain or bleeding continues, it is best to seek medical advice.

Can certain foods make fissure symptoms worse?

Yes. Spicy food, processed snacks, and low-fibre diets can make stools harder or more difficult to pass, increasing the risk of pain and re-tearing. A fibre-rich diet and adequate fluid intake are important for managing symptoms.

Is it okay to exercise with an anal fissure?

Light exercise, such as walking, can help stimulate digestion and prevent constipation. However, activities that involve heavy lifting or strain in the lower body may worsen discomfort and should be avoided during healing.

How long does it usually take for a fissure to heal?

Most acute fissures heal within 4 to 6 weeks with proper care. Chronic fissures may take longer and often need medical treatment to support healing. If there is no improvement within a few weeks, a medical review is important.

Is surgery always needed for a fissure that doesn’t heal?

Not always. Many chronic fissures respond to topical medicines or non-surgical options like Botox injections. Surgery is usually considered only if other treatments have failed or if the fissure is causing ongoing pain and limiting daily activities.

Are anal fissures linked to other health conditions?

Yes, in some cases, persistent or non-healing fissures can be linked to conditions such as inflammatory bowel disease or infections. If symptoms are unusual or severe, doctors may recommend further tests to rule out other causes.