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GI and Laparoscopic
An anal fissure is a small tear in the lining of the anal canal that can cause sharp pain, burning and bright-red bleeding during or after bowel movements. Treatment depends on whether the fissure is acute or persistent and may include fiber, fluids, stool-softening measures, warm sitz baths, prescription medicines, Botox or surgery when appropriate.
Updated: August 2026 | Department: GI & Laparoscopic Surgery
Persistent anal pain or rectal bleeding deserves medical evaluation because hemorrhoids and other conditions can cause similar symptoms.
Many anal fissures are initially managed without surgery by keeping stools soft and avoiding straining. A high-fiber diet, adequate fluids, fiber supplements or stool-softening measures, and warm sitz baths may help. Prescription topical medicines can be used for persistent fissures. Chronic or treatment-resistant fissures may be considered for Botox injection or lateral internal sphincterotomy after appropriate assessment.
An anal fissure, also called a fissure-in-ano, is a small tear or split in the lining of the anal canal. It commonly causes pain during bowel movements and may cause bright-red blood on toilet paper or in the toilet bowl.
Fissures can develop after passing hard or large stools, but diarrhea and other conditions can also contribute. Some acute fissures heal with conservative treatment, while persistent or recurrent fissures may need prescription treatment or a procedure.
Because rectal bleeding can have causes other than an anal fissure, ongoing or unexplained bleeding should be assessed by a healthcare professional.
Symptoms may vary, but pain and bleeding during bowel movements are common features of an anal fissure.
Sharp, tearing or burning pain may occur while passing stool and can continue afterwards.
A small amount of bright-red blood may appear on toilet paper or around the stool.
The skin around the anus may feel sensitive, irritated or tender.
Local itching or irritation may occur around the affected area.
Spasm or increased tightness of the internal anal sphincter can contribute to pain.
Pain may make a person avoid bowel movements, which can worsen constipation and straining.
Anal fissures can occur when the anal lining is stretched or injured. Constipation and hard stools are common triggers, but other conditions can also contribute.
Passing hard or large stools and straining can stretch the anal canal and contribute to a fissure.
Frequent loose stools can irritate the anal canal and may be associated with fissure formation.
Childbirth and local injury or trauma are among the factors associated with anal fissures.
Conditions such as Crohn's disease can be associated with anal fissures. Atypical or difficult-to-heal fissures may need evaluation for an underlying condition.
Diagnosis is often based on symptoms and examination of the anal area. Additional tests are considered when the diagnosis is uncertain or another condition needs evaluation.
A clinician reviews symptoms and examines the area around the anus for a visible fissure, tenderness or other findings.
A digital rectal examination may be considered when appropriate. Severe pain may affect whether it is performed immediately.
A small instrument may be used to inspect the anal canal when further visualization is needed.
Hemorrhoids and other bowel conditions can also cause bleeding. Persistent, recurrent or unexplained bleeding should be assessed.
Treatment is selected according to duration, symptom severity, response to conservative care and individual risk factors. Most acute fissures are initially treated without surgery.
Sitting in warm water for around 10–20 minutes can soothe anal pain and help relax the anal sphincter. It is commonly used as part of conservative care.
Depending on the diagnosis, a doctor may prescribe topical medicines such as a calcium channel blocker or nitrate to relax the internal anal sphincter and support healing.
Botulinum toxin can relax the internal anal sphincter. It may be considered for selected chronic fissures, particularly when topical treatment has not provided adequate healing.
Lateral internal sphincterotomy involves a controlled division of part of the internal anal sphincter to reduce excessive sphincter pressure and allow the fissure to heal. It is an established option for selected chronic or treatment-resistant fissures.
Surgery is not suitable for everyone. Existing fecal incontinence, previous sphincter injury, obstetric injury, inflammatory bowel disease and other factors can affect the decision. A surgeon should discuss benefits, alternatives and risks before treatment.
A fissure can recur, especially when constipation, hard stools or other contributing factors return.
Recurrent anal pain or rectal bleeding should be evaluated rather than repeatedly self-treated without identifying the cause.
Heavy or rapidly increasing rectal bleeding, fainting, severe weakness or other concerning symptoms require urgent medical attention.
Yes. Many acute anal fissures can improve with non-surgical care such as adequate fiber, fluids, stool-softening measures and warm sitz baths. Persistent or chronic fissures may need prescription treatment or a procedure.
Common symptoms include sharp or burning pain during bowel movements, pain that may continue afterwards, bright-red rectal bleeding, anal tenderness, itching and spasm.
Treatment depends on the individual. Prescription topical medicines and Botox are options for selected patients, while lateral internal sphincterotomy is an established surgical option for selected chronic or treatment-resistant fissures.
Healing time varies. Acute fissures may improve over several weeks with appropriate treatment, while chronic fissures can be more difficult to heal and may require prescription treatment or a procedure.
Yes. Recurrence can occur, particularly when constipation, hard stools or other contributing factors return. Maintaining comfortable bowel movements and treating underlying causes can help reduce recurrence risk.
Yes. Botulinum toxin can be injected into the internal anal sphincter to relax the muscle. It may be considered for selected chronic fissures, including some that have not responded adequately to topical treatment.
Lateral internal sphincterotomy is a surgical procedure in which a controlled portion of the internal anal sphincter is divided to reduce sphincter pressure and help a chronic fissure heal.
Seek medical evaluation for persistent or recurrent anal pain, ongoing rectal bleeding, symptoms that do not improve with appropriate care, recurrent fissures or symptoms that suggest another bowel condition. Heavy bleeding or fainting requires urgent attention.
A proper examination can help determine whether symptoms are due to an anal fissure or another anorectal condition and guide appropriate treatment.
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