Anal Fissure

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is an anal fissure?

An anal fissure is a small tear or split in the lining of the anal canal. Anal fissures are common among infants, but they can occur at any age. Anal fissures are also common among women who have recently given birth and people who have inflammatory bowel disease. An anal fissure can be acute or chronic (lasting beyond six weeks).

An anal fissure is marked by a burning sensation or pain in the rectum or anus. This sensation is most noticeable during a bowel movement. There may also be some bleeding from the fissure. Anal fissures can occur as the result of a large, firm bowel movement. Constipation, diarrhea, an inflammatory anal condition, or having receptive anal intercourse can also cause anal fissures. Anything that irritates or cuts the anal lining can result in an anal fissure. An anal fissure can recur easily.

If an anal fissure becomes a chronic condition, a small lump of skin may form on the outside of the anus. This is known as skin tag or sentinel pile.

An anal fissure will most likely heal on its own. Your health care provider may also recommend frequent warm baths to relax the anal muscles, which can also assist the healing process. A diet high in fiber and with plenty of liquids promotes softer bowel movements, which can help reduce the occurrence and recurrence of anal fissures. Stool softener and topical medications can also be used in treatment of anal fissure. In some cases, surgical intervention may be required to repair an anal fissure.

Seek prompt medical care if you are being treated for an anal fissure, but your symptoms persist, recur, or cause you concern.

What are the symptoms of an anal fissure?

Symptoms of an anal fissure include a burning sensation or pain in the rectum or anus. Anal fissure symptoms are most noticeable during bowel movements.

Common symptoms of an anal fissure

You may experience symptoms of anal fissure symptoms daily or just once in a while. At times, any of these anal fissure symptoms can be severe:

  • Blood-streaked stools
  • Bloody stools (blood may be red, black, or tarry in texture)
  • Burning feeling
  • Change in bowel habits
  • Change in bowel movements
  • Constipation
  • Diarrhea
  • Itching
  • Painful bowel movements
  • Rectal bleeding or blood in stool (melena)

Symptoms that might indicate a serious condition

Seek immediate medical care if you, or someone you are with, are being treated for an anal fissure and have any of these serious symptoms including:

  • Bloody stools (blood may be red, black, or tarry in texture)
  • High fever (higher than 101 degrees Fahrenheit)
  • Rectal bleeding or blood in stool (melena)
  • Recurring bouts of watery diarrhea that may include blood or pus

What causes an anal fissure?

An anal fissure can occur as the result of passing a large, hard stool (bowel movement). Constipation, diarrhea, or an inflammatory anal condition can also cause an anal fissure. Anything that irritates or cuts the anal lining can result in an anal fissure. People with Crohn’s disease, an inflammatory bowel disease, are more susceptible to an anal fissure. Women who have recently given birth may also experience an anal fissure. Receptive anal sexual intercourse can also cause anal fissure.

What are the risk factors for an anal fissure?

A number of factors increase the risk of developing an anal fissure. Not all people with risk factors will get an anal fissure. Risk factors for an anal fissure include:

Reducing your risk of an anal fissure

You may be able to prevent the occurrence or recurrence of an anal fissure by modifying your diet. A diet high in fiber, along with plenty of liquids, can promote softer bowel movements that are less likely to injure the tissues of the anal canal. Your health care provider may suggest frequent warm baths to relax the anal muscles. If you have an infant, you can lower your baby’s risk of an anal fissure by changing diapers frequently.

You may be able to lower your risk of an anal fissure by:

  • Avoiding irritation of the rectum or anus
  • Drinking plenty of liquids
  • Eating a diet high in soluble fiber
  • Keeping the anal area clean and dry
  • Taking an over-the-counter stool softener, such as psyllium (Fiberall, Metamucil) or methylcellulose (Citrucel)
  • Wiping the anus gently with a cotton pad or moistened cloth after a bowel movement

How is an anal fissure treated?

An anal fissure will most likely heal on its own. Ninety percent of first-time anal fissures heal within 3-4 weeks. Your health care provider may also recommend frequent warm baths to relax the anal muscles, which can also assist the healing process. A diet high in fiber and with plenty of liquids promotes softer bowel movements, which can help reduce the occurrence and recurrence of anal fissures. In some cases, surgical intervention may be required to repair an anal fissure.

Self-care anal fissure treatment

An anal fissure can be treated with self-care measures including:

  • Drinking plenty of liquids
  • Eating a diet high in soluble fiber
  • Keeping the anal area clean and dry
  • Taking a warm bath several times a day
  • Taking an over-the-counter stool softener such as psyllium (Fiberall, Metamucil) or methylcellulose (Citrucel)
  • Using an over-the-counter numbing cream if pain causes you to avoid bowel movements
  • Wiping the anus gently with a cotton pad or moistened cloth after a bowel movement

Other treatment for an anal fissure

If an anal fissure is recurrent, your health care provider may recommend treatments including:

  • Botulinum toxin (Botox) injection to relax the anal sphincter
  • Sphincterotomy (surgical procedure to improve healing of the anal fissure)
  • Topical anesthetics such as lidocaine (Lidocream, Anestacon) or tetracaine (Dermocaine, Viractin)
  • Topical medications such as nitroglycerin or nifedipine

What you can do to improve your anal fissure

You may be able to improve the healing of your anal fissure by:

  • Avoiding anal sexual intercourse
  • Avoiding irritation of the rectum and anus
  • Changing diapers frequently (for infants)
  • Drinking plenty of liquids
  • Eating a diet high in soluble fiber
  • Keeping the anal area clean and dry
  • Taking a warm bath after each bowel movement
  • Taking an over-the-counter stool softener such as psyllium (Fiberall, Metamucil) or methylcellulose (Citrucel)
  • Wiping the anus gently with a cotton pad or moistened cloth after a bowel movement

What are the potential complications of an anal fissure?

Anal fissures can recur easily. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of an anal fissure can include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 19
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Anal fissure. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002116/.
  2. Anal fissure. American Society of Colon and Rectal Surgeons. http://www.fascrs.org/patients/conditions/anal_fissure/.
  3. Rectal problems in women. American College of Gastroenterology. http://www.acg.gi.org/patients/women/rectal.asp.
  4. Kahan S, Miller R, Smith EG (Eds.). In A Page Signs & Symptoms, 2d ed. Philadelphia: Lippincott, Williams & Williams, 2009.