Anal fissures: An anal fissure is a small cut or tear in the lining of the anus. It sounds minor, but the pain can be sharp, burning, and out of proportion to the size of the wound. The good news: most acute fissures heal with the right home care and timely medical help.
Why do anal fissures happen?
- Hard, dry stools or constipation (the most common trigger) stretch and crack the delicate lining.
- Frequent diarrhoea irritates and inflames the area.
- Straining on the toilet or sitting too long.
- Post-pregnancy and postpartum changes.
- Tight anal sphincter (muscle spasm reduces blood flow and slows healing).
- Less commonly: infections, inflammatory bowel disease (IBD), trauma, or reduced blood supply.
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How do anal fissures feel?
- Sharp pain during a bowel movement, often described as “passing glass.”
- Burning or throbbing pain that can last minutes to hours afterwards.
- Bright red blood on toilet paper or on the stool (usually a streak, not mixed in).
- Spasm or a “tight” feeling in the anus.
- Itching or irritation.
- A small skin tag (“sentinel pile”) may form if the fissure becomes chronic.
First aid: what actually helps
Soften the stool: Aim for a soft, easy-to-pass stool daily. Add fibre (vegetables, fruits, whole grains, psyllium/isabgol) and drink enough water (most adults need ~2–2.5 L/day, unless your doctor advises otherwise).
Sitz baths: Soak the area in warm, not hot, water for 10–15 minutes, 2–3 times a day and after motions. This relaxes the muscle and eases pain.
Don’t strain: Use a footstool to elevate your feet; breathe and relax—no pushing. Respond to the first urge, don’t delay.
Pain relief: Simple oral painkillers can help short term if safe for you. A gentle stool softener may be used for a few days.
Keep the area clean and dry: Rinse with lukewarm water; pat, don’t rub. Avoid perfumed wipes and harsh soaps.
Avoid: long sitting on the toilet, repeated laxative “cleanses,” perfumed creams, and steroid ointments without medical advice (they can thin the skin when misused).
When to see a doctor
- Severe pain, bleeding that doesn’t settle in 3–5 days, or pain that persists beyond two weeks despite home care.
- Recurrent fissures or a visible skin tag with ongoing pain.
- Red flags: fever, pus/discharge, swelling, inability to pass stool/urine, dark or mixed-in blood, weight loss, night pain, or a history of IBD/colon disease. Seek care promptly.
- Pregnant or postpartum and in significant pain.
- Children or older adults with new bleeding.
Your clinician will examine you gently, sometimes with a local anaesthetic gel. Most cases don’t need scans. If infection or other conditions are suspected, tests may be advised.
Medical treatments your doctor may suggest
- Topical vasodilators (e.g., prescribed nitroglycerin/diltiazem/nifedipine creams) to relax the sphincter and improve blood flow.
- Short-term stool softeners and a fibre plan tailored to you.
- Botox injection for stubborn fissures to reduce spasm and allow healing.
- Surgery (LIS: lateral internal sphincterotomy) for chronic, non-healing fissures with high success rates when done by experienced surgeons.
Prevention that works
- A daily bowel routine: fibre + fluids + movement (walking helps).
- Don’t ignore the urge; avoid prolonged sitting on the toilet.
- Manage diarrhoea and constipation early.
- Pelvic floor relaxation and gentle core/hip strengthening to support bowel habits.
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Anal fissures are common and very treatable. Start with stool-softening strategies, sitz baths, and better toilet habits. If pain or bleeding persists, don’t suffer in silence; see a doctor early to prevent a short-term tear from becoming a chronic problem.
Health disclaimer: This article is educational and not a substitute for personalised medical advice. Do not start or stop prescription medicines without consulting your clinician.