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Anal fissure
Expert reviewer, Mrs Sara Badvie, Consultant Laparoscopic, Colorectal and General Surgeon
Next review due May 2024
An anal fissure is a small tear or ulcer (open sore) in the skin just inside your anus (bottom). It causes severe pain and, sometimes, bleeding when you have a bowel movement (poo). Anal fissures often go away by themselves with some simple self-help measures. But if they don’t, there are several treatments that can help.
About anal fissure
Anal fissures develop in the skin lining your back passage, just inside your anus (your anal canal). They usually develop towards the back of your anus, but you can sometimes get one at the front or even both together. If you have a condition that’s causing your anal fissures – for example, Crohn’s disease – you may get them anywhere around your anus.
If you’ve had an anal fissure for less than six weeks, it’s called an acute anal fissure. If it lasts for longer than six weeks, it’s known as a chronic anal fissure.
Anal fissures are common. It’s thought that around one in 10 people get one at some point in their life. Anyone can get an anal fissure, including children, but it’s most common in people aged 15 to 40.
Causes of anal fissure
For most people who develop an anal fissure, there isn’t any obvious reason why. This is called a primary anal fissure. It’s often thought to be the result of a hard or painful bowel movement damaging your anal canal. This can cause the muscles around your anus (the internal sphincter muscles) to spasm and tense up, making you more likely to tear. It also reduces the blood supply to the area, which makes it harder for any tears to heal.
Sometimes, there is a clear underlying cause for your anal fissure. This is known as a secondary anal fissure. Causes of secondary anal fissures include the following.
- Constipation – passing a hard poo can cause a tear.
- Being pregnant or giving birth – this can put pressure on your perineum (the area between your anus and vulva).
- Having an inflammatory bowel disease such as Crohn’s disease.
- Having a sexually transmitted infection or a skin infection.
- Having a skin condition such as psoriasis.
- Taking medicines such as painkillers containing opioids or having chemotherapy.
- Having had trauma to your anus – for example, through having anal sex or through surgery.
- Having bowel cancer.
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Need a GP appointment? Telephone or Video GP serviceSymptoms of anal fissure
Anal fissure symptoms may include the following.
- A sharp, searing or burning pain in or around your bottom when you poo. Some people describe this as feeling like ‘passing broken glass’. You may continue to feel a deep, burning pain for several hours afterwards.
- Bleeding when you poo. Not everyone has bleeding with an anal fissure. But if you do, you might see blood in the toilet bowl or on the toilet paper after you’ve had a poo.
- Spasms (sudden tightening) in the muscles around your anus when you poo.
- A tearing sensation in your anus when you poo.
These symptoms may not always be due to an anal fissure. Other conditions, like piles (haemorrhoids) can cause similar symptoms. If you have any of the symptoms above, contact your GP for advice. It’s always important to seek medical advice if you notice bleeding from your bottom.
Diagnosis of anal fissure
Your GP will usually be able to diagnose an anal fissure by asking about your symptoms and examining you. They’ll ask you to describe your symptoms and how long you’ve had them. They may also ask you about your health in general and your medical history.
Your doctor will examine you by asking you to lie on your side with your knees bent towards your chest. They’ll then gently part your buttocks to examine the area and see if there’s a fissure.
If there’s any uncertainty about what’s causing your symptoms or if initial treatments don’t help, your GP may refer you to see a colorectal surgeon. This is a surgeon who specialises in conditions affecting your bowel and back passage.
What should I do if I’m embarrassed to talk to my doctor?
Bupa GP, Naveen Puri, talks about what you should do if you’re having symptoms you’re worried to discuss with your doctor.
What should I do if I’m embarrassed to talk to my doctor?
Bupa GP, Naveen Puri, talks about what you should do if you’re having symptoms you’re worried to discuss with your doctor.
Hello, I am Dr Naveen Puri, I am one of the GPs within Bupa Health Clinics.
Today I want to speak to you about embarrassing problems you might have and what we can do if you attend one of our clinics.
I want you to know that many people feel embarrassed or concerned about speaking about certain things with their doctors, but I'm here to reassure you these are the kinds of things we deal with every day.
For me, looking at someone's bottom or their breasts or their genitalia is no different to looking at their nose or elbow.
And that's true for all doctors as we train for many years in these parts of the body and are very used to having these conversations with people just like you.
So what I would encourage you to do if you have any concerns from your perspective, be it a change in your bowel habit, be it a lump, a rash, a swelling. Something on your genitalia or a part of your body you're not particularly familiar with or feel uncomfortable discussing.
Please be assured your doctor has done it all before.
Some of the ways we find patients find it easier to speak to a doctor is to either tell the doctor you feel embarrassed up front. That way a doctor can make extra effort to make sure you feel comfortable.
Or some patients come to us with pieces of paper and will write the problem down and hand it to us. That way we can help with whatever is going on for you as well.
You may also find it helpful to ask for a specific doctor, someone you're familiar with in your practice. Or you might want to ask for a doctor of a specific gender, or background to your liking as well.
I'd also say, doctors do this every day so don't be alarmed if we ask you certain questions around your symptoms. It is purely so we can help you get the best outcome for your enquiry.
And then finally, feel free to use language that suits you as well. We don't expect you to know the medical words for things, or a name for your diagnosis. That's our job to find out for you.
So, take your time, see a doctor, and hopefully we can help put your mind at ease.
Self-help
Most anal fissures heal by themselves within six to eight weeks. There are a number of ways to help the fissure heal and to relieve your pain and discomfort. These include the following.
- Gradually increase the fibre in your diet up to 30g per day by including plenty of wholegrain foods, fruit and vegetables. This will help keep your poo soft and easier to pass.
- Make sure you’re drinking enough fluids, especially if you’re increasing your fibre intake.
- Keeping the area clean and dry will help with healing and with preventing infection.
- Make sure you go to the toilet as soon as you feel the need to poo and try not to strain when you go. ‘Holding on’ and straining can make a fissure worse – this can be a common cycle in children.
- Try sitting in a warm bath to relieve any pain, particularly after you’ve had a bowel movement.
- Take over-the-counter painkillers such as paracetamol or ibuprofen to help manage any pain. You can buy these without a prescription. Make sure you read the patient information leaflet in the packet.
Treatment of anal fissure
If your pain is particularly severe or your symptoms aren’t improving with self-help measures, there are a number of treatments your doctor may suggest.
Medicines
The following medicines can help to relieve pain associated with an anal fissure or help the fissure to heal.
- Laxatives or stool softeners such as ispaghula husk or lactulose. These can help if you’re constipated. They work by softening your poo and making it easier to pass. You can buy laxatives over the counter from a pharmacy without a prescription. A doctor will need to prescribe them if it’s for a child.
- Anaesthetic ointment (for example, lidocaine). Your GP may prescribe this for a few days if you’ve been having extreme pain when you poo. You apply this ointment to your anus to help numb the area before you have a bowel movement.
- Glyceryl trinitrate (GTN) ointment. This helps to relax the sphincter muscles in your bottom, which improves blood flow to the area and helps the fissure to heal. Your GP may prescribe GTN ointment if you’ve had a fissure for over a week and other measures don’t seem to be helping. You’ll need to use it for six to eight weeks. You should keep using the ointment for the full time to prevent your fissure from coming back.
- Calcium-channel blockers (for example, diltiazem cream). Like GTN ointment, this medicine relaxes the muscles in your bottom and improves blood flow to the area. It’s associated with fewer side-effects than GTN ointment. This medicine can usually only be prescribed by a specialist colorectal surgeon. Your GP may refer you if you’re not able to tolerate GTN or if you have a chronic anal fissure.
If a child’s fissure doesn’t heal after a couple of weeks, their GP may refer them to a paediatrician.
Procedures to treat anal fissure
If other treatment options haven’t helped your anal fissure to heal or it keeps coming back, your GP may refer you to a colorectal surgeon. Your surgeon will talk to you about what other options they may recommend. Options include the following anal fissure procedures.
- Botulinum toxin (Botox) injections. In this procedure, your surgeon will inject Botox directly into the sphincter muscle in your bottom. The aim is to temporarily relax this muscle so that your fissure can heal.
- Fissurectomy. This involves cutting away the damaged skin around your anal fissure. Your surgeon may suggest you have this alongside Botox injections.
- Lateral internal sphincterotomy. This is a type of surgery that involves cutting the sphincter muscles in your bottom. This releases the tension around your anus and lets your fissure heal. Your doctor will usually only suggest this after you’ve tried other treatments, including Botox.
- Anal advancement flaps. This involves taking healthy skin from your anal lining and using it to replace the broken skin in your fissure. You may have it at the same time as a sphincterotomy or afterwards if your fissure still doesn’t heal.
Prevention of anal fissure
You can reduce your risk of developing an anal fissure by preventing constipation. This is really important if you’ve already had an anal fissure that’s healed, as it can help to stop the fissure from coming back. You can help to prevent constipation by making sure you have a healthy balanced diet that contains plenty of fibre. It’s also important to make sure you’re drinking enough fluids and exercising regularly.
If you have another health condition that increases your risk of getting an anal fissure, speak to your doctor. They will tell you the best way to manage your condition and reduce your risk of getting an anal fissure.
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What is an anal fissure? What is an anal fissure?
An anal fissure is a small tear in the skin just inside your bottom. It can be very painful when you have a poo.
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How do you know if a fissure is healing? How do you know if a fissure is healing?
You’ll start to notice your symptoms improving as your fissure is healing. Your pain should lessen and if you had any bleeding, this should stop too. You should have a follow-up appointment with your doctor after six to eight weeks. This is to check that the fissure has healed.
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How long do anal fissures take to heal? How long do anal fissures take to heal?
Most anal fissures heal within six to eight weeks if you make changes to your diet and lifestyle and take medicines for pain relief. Sometimes, anal fissures heal more quickly than this. Sometimes, they last for longer and you may need further treatment.
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Do anal fissures always hurt? Do anal fissures always hurt?
You’ll usually experience severe pain when you have a poo if you have an anal fissure. But it’s also possible to have an anal fissure and not have any pain.
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Are anal fissures dangerous? Are anal fissures dangerous?
Anal fissures can be really painful but they’re treatable and aren’t usually a serious problem. But they can sometimes lead to other problems such as infection. If you avoid going for a poo because of a fissure, it can lead to faecal impaction. This is when you have a large blockage of poo in your bowels.
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What is a chronic anal fissure? What is a chronic anal fissure?
A chronic anal fissure is one that you’ve had for longer than six weeks. It might mean that you need specialist treatment or a procedure to get rid of your fissure.
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Related information
Anal fissure procedures
If you have an anal fissure that hasn’t healed with other treatments, your doctor may suggest surgery.
Constipation
Constipation is a common condition that affects your usual pattern of bowel movements.
Fibre
Here we explain why you need fibre, and give you some tips for getting more of it into your diet.
Piles
Piles, also known as haemorrhoids, are swollen veins and muscle around your anus or in your anal canal.
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Sources Sources
- Anal fissure. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised January 2017
- Anal fissure. BMJ Best Practice. bestpractice.bmj.com, last reviewed 20 March 2021
- Anal fissure. Medscape. emedicine.medscape.com, updated 24 July 2020
- Anal fissure. Patient. patient.info, last edited 6 March 2017
- Suspected cancer: recognition and referral. National Institute for Health and Care Excellence (NICE), last updated 29 January 2021. www.nice.org.uk
- Fibre. British Dietetic Association (BDA). www.bda.uk.com, published September 2016
- Constipation. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2020
- Constipation in children. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2015
- Conditions for which over-the-counter items should not routinely be prescribed in primary care: Guidance for CCGs. NHS England, 29 March 2018. www.england.nhs.uk
- Anorectal disorders. Colorectal surgery. Oxford Medicine Online. oxfordmedicine.com, published online October 2011
- Surgery for anal fissure. Technique. Medscape. emedicine.medscape.com, updated 10 August 2020
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Author information Author information
Reviewed by Pippa Coulter, Freelance Health Editor, May 2021
Expert reviewer, Mrs Sara Badvie, Consultant Laparoscopic, Colorectal and General Surgeon
Next review due May 2024
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