Anal Fissure

Last Updated January 2021 | This article was created by familydoctor.org editorial staff and reviewed by Peter Rippey, MD, CAQSM

What are anal fissures?

An anal fissure is a small crack or tear in the thin, moist lining of the lower rectum. It’s a common condition. Sometimes people confuse anal fissures with hemorrhoids.

Symptoms of anal fissures

The most common symptom of an anal fissure is a shooting pain in the anus and surrounding area. Anal fissures often cause painful bowel movements and bleeding. You may also see blood on the toilet paper after wiping. Anal fissures may also cause itching in the anal area.

What causes anal fissures?

Anal fissures are usually a result of straining during a bowel movement, causing injury to the anal canal. They also can be caused by repeated diarrhea, when blood flow to the area is decreased (in older adults), after childbirth, or in people with Crohn’s disease.

How are anal fissures diagnosed?

Your doctor will perform a rectal exam. Usually, a visual exam is all that’s necessary to see the fissure. Your doctor might have to insert a lubricated, gloved finger into the anal canal.

Can anal fissures be prevented or avoided?

Keeping bowel movements regular and avoiding constipation can help reduce your chances of an anal fissure. Add more fruits, vegetables, and whole grains to your diet to get enough fiber. Drink plenty of fluids and get some exercise in every day to help keep your digestive system moving.

Anal fissure treatment

About half of all fissures heal by themselves and need no treatment at all. If fissures don’t heal on their own, other treatments may involve prescription creams such as nitrates or calcium channel blockers. You may even need Botox injections into the muscle in the anus (called the anal sphincter). Minor surgery to relax the anal muscle can be used as a last resort.

Living with anal fissures

Your doctor may prescribe stool softeners to make going to the bathroom easier and less painful while the fissure heals. Numbing cream can also make bowel movements less painful. Petroleum jelly, zinc oxide, 1% hydrocortisone cream, and products like Preparation H can help soothe the area. Instead of toilet paper, use alcohol-free baby wipes that are gentler on the area.

Sitz baths can help heal fissures and make you feel better. Fill the tub with enough lukewarm water to cover your hips and buttocks. Don’t use soap or bubbles or any other products unless prescribed by your doctor. Relax in the sitz bath 2 to 3 times a day for about 10 minutes at a time.

People who develop fissures once are more likely to have them in the future, so it’s important to keep bowel movements regular. If you’ve had a fissure in the past, you may be tempted to hold your bowel movement in to avoid the pain of passing it. But that’s not a good idea. That can make stools become hard and difficult to pass, which will make the fissure worse. Continue with a high-fiber diet and drink plenty of liquid to help make stools easy to pass.

Questions for your doctor

  • How can I add more fiber to my diet?
  • Should I use fiber supplements?
  • Should I use laxatives?
  • What products do you recommend I use while I have the fissure?