Anal Fissures: An Overview

An anal fissure is a tear or rip in the lining of the anal canal. Here’s what you need to know about anal fissures.

Causes and Risk Factors

Anal fissures are most often caused by trauma in the anal canal. They can be caused by straining during a bowel movement, chronic diarrhea, anal intercourse, childbirth, and anything else that may cause trauma in the canal. Anal fissures are most common in infants, but can occur at any age. Other risk factors include childbirth, constipation, and crohn’s disease.

Symptoms of Anal Fissures

This condition is characterized by a few symptoms. The most common symptoms include pain and bleeding with bowel movements. You may experience pain during and after a bowel movement, even hours later, with an anal fissure. Many people with this condition may notice blood on the outer surface of stool or blood on toilet paper after a bowel movement. Other symptoms can include a visible crack around the anus, burning and itching, constipation, and foul-smelling discharge around the fissure.


Doctors diagnose anal fissures with a physical examination and asking about your medical history. They examine your anal region and look for a visible tear that indicates a fissure. They may be able to determine the nature of the fissure during the examination as well. An acute fissure will likely look like a fresh and more shallow tear, whereas a chronic case may have a deeper tear. Chronic anal fissures last longer than eight weeks.

Additionally, where your fissure is located will provide important clues for your doctor. Fissures that are on a side of your anal opening are more likely to be a result of an underlying condition like Crohn’s disease. If your doctor finds this is the case for you, they may order additional testing. They can perform a number of endoscopic procedures to get a closer look at the underlying issue. These procedures could include a colonoscopy, flexible sigmoidoscopy, or anoscopy, depending on other factors in your unique situation.

Treating Anal Fissures

Doctors treat anal fissures primarily by helping to make your stools softer, decreasing the pressure in the anal canal. They may recommend soaking in a warm bath (sitz bath) for 10-20 minutes per day, which can help relax your sphincter. They may also prescribe stool softeners or recommend you drink more water and eat more fiber. All of these steps can help to soften your stool and promote healing. In most cases, this can help heal an anal fissure in a few weeks.

In some cases, anal fissures can persist after these treatments. Your doctor may prescribe a topical muscle relaxant, nitroglycerin (to relax the sphincter), or other medicine to help with pain. In some cases, you may need surgery to fix an anal fissure. This is usually the case only if your symptoms are severe and chronic, and have not responded to other treatment. Surgery involves cutting a small part of the sphincter muscle to reduce spasms and promote healing. It’s very effective, but does carry a small risk of causing incontinence.

Our experienced team at GHP has years of experience treating patients with conditions including anal fissures. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.