What are anal fissures?
Anal fissures are small tears or cuts in the lining of the anal canal, where stool leaves the body. They can happen when you strain to pass a hard or large bowel movement. Sometimes, they can also be caused by injury or trauma to the area.
Anal fissures are often painful, especially during or after a bowel movement. You might also notice bright red blood on toilet paper or in the toilet after using the bathroom. While anal fissures can feel similar to hemorrhoids, there are some differences. Hemorrhoids often cause painless bleeding, while fissures usually come with sharp pain.
Anal fissures can also look like other conditions, such as anal fistulas, which involves a tunnel forming under the skin. That’s why it’s important to see a doctor if you notice blood in your stool or have ongoing pain. These symptoms can sometimes be signs of something more serious, like colorectal cancer—and early detection is important for the best outcomes.
At MedStar Health, our experienced team of gastroenterologists and colorectal surgeons work together to diagnose and treat anal fissures using the least invasive methods whenever possible. We take a collaborative approach to care, making sure you get the right treatment from the right specialists, all in one place.
What causes anal fissures?
Several everyday things can increase your risk of developing an anal fissure. These include:
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Constipation: Hard or dry stools can stretch and tear the skin around the anus.
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Straining or pushing during bowel movements: This puts pressure on the anal canal and can lead to injury.
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Spending too much time sitting on the toilet: This can reduce blood flow to the area and make it easier for tears to happen.
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Direct trauma to the area: Injury to the anus can sometimes cause fissures.
Anyone can get an anal fissure, but these risk factors make it more likely. If you’ve had pain or bleeding during or after a bowel movement, it’s a good idea to get checked, as early treatment can help prevent symptoms from getting worse.
What do anal fissures look and feel like?
Anal fissures can be very uncomfortable and are often mistaken for other conditions, like hemorrhoids. The most common symptom is sharp, burning pain during or after a bowel movement. Some people describe it as feeling like they’re “passing glass.”
Other anal fissure symptoms include:
- Bright red blood after a bowel movement
- A visible tear or cut in the skin around the anus
- Itching or irritation around the area
- Spasms or tightness in the anal muscles after using the bathroom
While hemorrhoids also cause bleeding, they usually don’t cause as much pain. Whether you’re dealing with painful or bloody stools, it’s important to get checked by a specialist to find out what’s causing your symptoms.
Our team can help determine if it’s an anal fissure or another condition and create a treatment plan to help you heal.
How are anal fissures diagnosed?
At MedStar Health, our gastroenterologists and colorectal surgeons work together to diagnose and treat anal fissures with care and expertise.
In many cases, your doctor can diagnose an anal fissure with a simple gentle physical exam, called a digital rectal exam (DRE). This involves carefully feeling the area with a gloved, lubricated finger to check for a tear.
Sometimes, your provider may recommend an anoscopy, which uses a small, tube-shaped device called an anoscope to get a better look inside the anal canal. This is usually quick and done in the office.
In certain cases, especially if your symptoms might be caused by something else or if bleeding is coming from higher in the digestive tract, your doctor may recommend a colonoscopy to rule out more serious conditions, such as colon polyps or colorectal cancer.
What are the treatment options for anal fissures?
We understand that every patient is different. That’s why anal fissure treatment is personalized based on your symptoms, whether the fissure is new or chronic, and what might be causing it. Our goal is to help you heal while also addressing the root cause, like constipation or muscle tension, to reduce the likelihood of the fissure coming back.
First-line treatment: Comfort and healing at home
For many people, anal fissures can heal on their own with simple, non-invasive treatments, especially when they’re caught early. These comfort measures can help relieve pain and reduce irritation:
- Taking warm sitz baths (sitting in a few inches of warm water several times a day)
- Eating more fiber through fruits, vegetables, or supplements
- Drinking plenty of water
- Using stool softeners to make bowel movements easier
These steps can help relieve constipation and reduce straining, which gives the tear time to heal.
Medications to relieve pain and promote recovery
If the fissure doesn’t heal with home care alone, your doctor may recommend topical medications such as:
- Lidocaine cream or ointment to numb the area and relieve pain
- Medications that help the muscles of the anus relax
These treatments are usually applied directly to the affected area and can be very effective, especially for chronic fissures.
When surgery is needed
In more severe or long-lasting cases, your doctor may recommend surgery. One common outpatient procedure is called a lateral internal sphincterotomy, where a small cut is made in the anal muscle to help it relax and allow the fissure to heal. In some cases, debridement (removing damaged tissue) may also be done.
Surgery can be highly effective, but it also comes with risks, including a small chance of fecal incontinence (trouble controlling bowel movements). That’s why our team works closely with you to weigh the benefits and risks of each option and explore less invasive treatments first, whenever possible.
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Expert gastroenterology care
Getting the care you need starts with seeing one of our gastroenterologists.
Frequently asked questions
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Will an anal fissure heal on its own?
Yes, many anal fissures heal on their own with home remedies like sitz baths, eating more fiber, staying hydrated, and avoiding constipation. The key is to reduce straining during bowel movements and give the area time to heal. If your fissure doesn’t improve within a few weeks, or if it keeps coming back, it’s time to see a specialist.
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What’s the difference between an anal fissure and hemorrhoids?
Both conditions can cause bleeding, but they feel different. Anal fissures usually cause painful bowel movements. Hemorrhoids are swollen veins that often cause painless bleeding, itching, or a feeling of pressure. A doctor can examine the area and tell you which condition you have—or if it’s both.
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Is surgery the only way to treat an anal fissure?
No. Surgery is usually only considered if the fissure doesn’t heal with other treatments. Most people get better with non-surgical care like dietary changes, sitz baths, and prescription creams. If surgery is needed, it’s typically a quick outpatient procedure with a high success rate.
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What does recovery look like after anal fissure surgery?
Surgery for anal fissures is usually done on an outpatient basis, which means you can go home the same day. Most patients return to normal activities within a few days, although full healing can take a few weeks. It’s common to have mild pain or discomfort after surgery, but this usually improves quickly and can be managed with medication and sitz baths.
We’ll provide clear instructions for anal fissure recovery, including how to keep the area clean, manage pain, and avoid constipation, all of which are important for healing.