Anal Fissure: Frequently Asked Questions

Medically Reviewed By William C. Lloyd III, MD, FACS
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Pain in the rear end

Often confused with hemorrhoids, anal fissures lead to pain and discomfort at the end of your rectum. Not only could you experience discomfort while sitting, but you also could experience pain during a bowel movement. Unfortunately, anal fissures are quite common and can affect both men and women, particularly between the ages of 20 and 40, although they can occur at any age. For many people, an anal fissure is an unknown entity, one that may leave them embarrassed and in pain.

What is an anal fissure?

An anal fissure is a small tear in the lining of the anal canal at the end of your rectum. A bowel movement, an anal infection, or an inflammatory bowel disease could cause an anal fissure. Symptoms include pain during a bowel movement, bright red blood in the stool, and a small lump or skin tag near the anal fissure. To avoid the pain of anal fissure, some patients may try to stop bowel movements, which could lead to fecal impaction.

What are the treatments for anal fissures?

There are a number of nonsurgical therapies available for anal fissure treatment. These include:

  • Fiber supplements
  • Stool softeners
  • Increased water intake
  • Warm soaking baths (sitz bath)
  • Lidocaine for pain relief
  • Medications, including diltiazam, nifedipine or nitroglycerin ointment to relax the anal sphincter muscles

Surgery is not traditionally an anal fissure treatment, but may be necessary for patients suffering from chronic anal fissures. Regardless of which treatment you decide on, it may take up to 10 weeks for complete healing of an anal fissure.

Do anal fissures itch?

Yes, anal fissures can itch due to irritation of the tissue surrounding the anal canal, which can become very uncomfortable. To help stop the itch, make sure you thoroughly dry the area following a bowel movement. Applying non-medicated talcum powder or topical creams, such as hydrocortisone or zinc oxide also can help alleviate itching. Placing a piece of clean cotton gauze against the itchy spot may absorb excess moisture that could lead to itching. Whatever you do, don’t scratch the itch. This will prolong the itching and delay healing. Clean the area with a gentle cleanser and pat dry.

Do anal fissures bleed or become infected?

Blood in the stool or on toilet paper following a bowel movement is a common symptom of an anal fissure. However, ongoing or heavy bleeding may indicate a more serious condition, so talk with your doctor right away if this occurs. With proper treatment, an anal fissure typically does not become infected. If your anal fissure does not heal in a timely manner, it’s possible the tear may become infected, which could require medication to heal.

Is an anal fissure a precursor to colorectal cancer?

No, anal fissures are not a risk factor of colorectal cancer. They also do not lead to colorectal cancer. It may seem that way because anal fissure symptoms, such as rectal bleeding and blood in the stool are possible symptoms of colorectal cancer. If you experience these symptoms after an anal fissure has fully healed, you should speak to your doctor. Additional tests may be necessary to rule out more serious conditions, such as colorectal cancer.

What are the complications of an anal fissure?

One of the most prevalent complications of anal fissures is recurrence. They become more common after you initially have one. Another possible complication is a larger tear that reaches farther into the muscle surrounding the end of the rectum. This could be more difficult to treat and heal. Anal fissures that fail to heal within eight weeks are considered a chronic condition, which could require surgical treatment.

How does anal fissure treatment reduce the risk of complications?

Staying hydrated and eating a high-fiber diet can help heal your anal fissure so it does not develop into a larger tear in the muscle. Use a mirror to examine your anus once a week. Do this every day during treatment and once a week thereafter. When you know what your healthy bottom looks like, you’ll be able to spot signs of a problem, such as increased redness, sores and bumps, and seek prompt treatment if necessary.

How can I lower my risk of anal fissures?

To help reduce your risk of anal fissures, it’s important to maintain a healthy diet that contains fiber and plenty of water. Take steps to promote healthy and regular bowel movements to reduce the stress on your anal canal. Anal intercourse also can lead to anal fissures. Applying a water-soluble lubricant before sex can help reduce the risk of an anal fissure. Abstain from anal intercourse if you have an anal fissure.

Other risk factors for anal fissures include childbirth and Crohn’s disease.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Dec 12
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