Anal Fissure
Causes, symptoms, diagnosis and treatment. Learn what an anal fissure is, how it’s treated, and when to seek specialist assessment.
Anal fissure: causes, symptoms and treatment
What is an anal fissure?
An anal fissure is a small crack, tear or cut in the lining of the anus (back passage). Fissures may be acute (recent) or chronic (long-standing or recurring). A chronic fissure may be associated with a small lump/skin tag (“sentinel pile”) which is often mistaken for piles (haemorrhoids).
Why do anal fissures occur?
Many fissures occur without a clear reason, but direct trauma to the anal lining is a common factor. The most frequent trigger is constipation and passing a hard, dry stool. Other causes include diarrhoea, inflammatory conditions of the anal area, and fissures can also occur after childbirth.
Tip: Keeping stools soft and regular is one of the most effective ways to support healing and reduce recurrence.
Symptoms of an anal fissure
- Pain (especially during or after bowel movements)
- Bleeding (often small amounts of fresh blood)
- Sometimes discharge if an abscess is associated
- Avoiding bowel motions because of pain can worsen constipation
Get checked if pain/bleeding persists, symptoms recur frequently, or you’re unsure it’s a fissure. Conditions like piles can look similar, so a proper examination matters.
How is an anal fissure treated?
Many fissures improve with measures that treat constipation or diarrhoea. Acute fissures are commonly managed with non-operative treatment:
- High-fibre diet and/or fibre supplements (bulking agents)
- Stool softeners and plenty of fluids
- Warm baths (10–20 minutes, several times daily) to soothe and relax the anal muscles
- Prescription creams to reduce sphincter spasm (e.g., GTN/Rectogesic or diltiazem/Anoheal)
If symptoms persist and the fissure becomes chronic, additional treatments may be considered.
Is non-operative treatment successful long-term?
Fissures can recur, especially after a hard bowel movement. Even once symptoms settle, maintaining good bowel habits and fibre intake helps reduce recurrence. If symptoms return without an obvious trigger, further assessment is sensible.
What can be done if a fissure doesn’t heal?
A fissure that doesn’t respond to treatment should be re-examined. Persistent constipation/diarrhoea, scarring, or internal sphincter spasm can delay healing. Other conditions (including inflammatory bowel disease, infections, or anal growths) can mimic fissure symptoms and should be excluded in persistent cases.
Operations and risks
If non-operative measures fail, your surgeon may recommend an examination under anaesthetic (EUA), possibly with biopsy. Options may include:
- Botox injection to relax the sphincter muscle (effect is temporary)
- Lateral internal sphincterotomy (small cut to reduce spasm and improve blood supply) — effective, with low recurrence, but a small risk of bowel control issues
- Less common options: anal stretch or anoplasty; sentinel skin tag removal in selected cases
Important: Surgery is usually considered only after trying non-operative treatments first.
FAQs
How long does healing take after surgery? Complete healing is usually within weeks, and pain often improves within days.
Can fissures lead to colon cancer? No, but persistent bleeding still needs careful evaluation because other conditions can cause similar symptoms.
Can I be treated privately? Yes — private assessment and treatment options may be available, including Botox injection or surgery if needed.