An anal fissure is a small tear in the lining of the anus, most commonly occurring in the posterior midline. It is one of the most frequently seen anorectal conditions and is especially common in individuals aged 20–39. Anal fissures typically develop due to trauma in the anal canal caused by factors such as constipation, diarrhea, childbirth, or surgical interventions.
What Is an Anal Fissure?
The question “What is an anal fissure?” is quite common. In simple terms, an anal fissure—also known as an anal tear—is a small split or crack in the skin of the anal canal. These tears may develop due to straining during defecation, passing hard stool, or frequent wiping during episodes of diarrhea.
Because the area is highly sensitive, anal fissures can cause severe pain. Patients often describe the pain as “a sharp, cutting, glass-like sensation during bowel movements.” Depending on the size and depth of the fissure, bright red bleeding may also occur.
In some cases, the fissure can extend deeper into the anal canal, which may prolong healing. For this reason, individuals experiencing symptoms should be evaluated by a colorectal surgeon.
What Is an Acute Anal Fissure?
Acute anal fissures are those with symptoms lasting less than 4 weeks. They appear as superficial linear tears on the mucosa. Patients typically experience intense pain and drop-like bleeding. Acute fissures are shallow and do not show surrounding skin thickening.
What Is a Chronic Anal Fissure?
A chronic fissure is one that has persisted for more than 4 weeks. Chronic fissures tend to resist healing. Their edges become thickened, and fibers of the internal anal sphincter may become visible at the base of the tear. A skin tag (sentinel pile or fibroepithelial polyp) may also develop beside the fissure, indicating a long-standing condition.
What Causes an Anal Fissure?
The most common cause of anal fissures is overstretching or irritation of the anal skin. This leads to increased sphincter tightness and tear formation. Many lifestyle and bowel habit factors contribute to fissure development.
Common causes of anal fissures include:
- Hard stools and constipation, which stretch and tear the sensitive anal skin
- Chronic diarrhea, causing repeated irritation
- Excessive straining during bowel movements
- Vaginal delivery, which may overstretch the anal region
- Poor dietary habits that lead to hard stools
- Inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease
- Sitting for long periods, which reduces blood circulation to the anal area
Symptoms of Anal Fissure
Common symptoms include:
- Severe pain during or after bowel movements
- Burning or stabbing sensations in the anal area
- Bleeding during or after defecation
- Itching or tenderness around the anus
- Visible cracks or tears
- Difficulty passing stool due to pain
How Does an Anal Fissure Develop?
An anal fissure forms due to a combination of tissue stretching, muscle spasm, and reduced blood flow. Chronic constipation is one of the leading causes. Hard stool stretches the mucosa, causing it to tear. Once torn, the area becomes hypersensitive, and the wound may reopen during each defecation.
How Is an Anal Fissure Diagnosed?
Diagnosis is made through a careful physical examination by a specialist. When necessary, endoscopy may be used to evaluate the rectum and colon.
How Is an Anal Fissure Treated?
The most frequently asked question is: “How is an anal fissure treated?” The first step is correcting constipation. A personalized, fiber-rich diet including whole grains, fruits, vegetables, and seeds is essential.
Patients should drink 2–2.5 liters of water daily. If constipation persists despite dietary adjustments—or in postpartum cases—stool softeners may be recommended.
Sitz baths with warm water, topical creams or ointments prescribed by the physician, and pain relievers can help reduce symptoms. Early-stage fissures typically heal with medication and lifestyle changes. Chronic or non-healing fissures may require surgery.
Non-Surgical Treatment Options
Medication
Topical creams that relax the anal sphincter are commonly used. Some creams may cause headaches or low blood pressure. Local anesthetic creams can be applied 10 minutes before and after defecation.
Botox Injection
Although Botox is used widely in medicine, its role in chronic fissure treatment is limited. While it may relax the anal sphincter, healing rates remain modest, and post-procedure pain is common. Repeated injections may lead to incontinence (gas or stool leakage).
Because of these limitations, our clinic does not use Botox for chronic fissures.
Treatment of Acute vs. Chronic Anal Fissure
Acute Fissure
Most acute fissures heal without surgery through:
- Regulating bowel habits
- Warm sitz baths
- Sphincter relaxation
- Topical medications
Dietary fiber, regular meals, avoidance of straining, and drinking a large glass of warm water in the morning can support recovery.
Chronic Fissure
Chronic fissures develop after incomplete healing or recurrence. They are deeper, inflamed, and often accompanied by sphincter spasm and prolonged pain. Severe pain lasting 20–25 minutes after bowel movements is typical.
What Is Anal Fissure Surgery?
Surgery is required when the fissure becomes chronic, painful, bleeds, or forms a sentinel pile.
The most common surgery is Lateral Internal Sphincterotomy (LIS), where the internal anal sphincter is cut. Although effective, LIS may cause complications such as:
- Fecal or gas incontinence (up to 25% in some studies)
- Recurrence (up to 10%)
- Rare cases of abscess or fistula
High complication rates are mainly due to complete division of the sphincter. Partial cuts reduce risk, but complete healing may still not occur.
Flap (Advancement Flap) Surgery for Chronic Anal Fissure
Flap surgery is preferred for chronic, non-healing fissures. The fissure tissue is removed, and the area is repaired using a small flap of the patient’s own tissue. This increases blood flow and speeds healing. It is ideal for deep fissures or those with sentinel piles.
Is Flap Surgery Successful?
Studies show excellent success rates with low incontinence risk. Our clinical experience confirms these results (reference: Ulutas Medical Journal).
How We Perform Flap Surgery
We excise the fissure and correct associated anal stenosis using anoplasty.
If anal pressure is normal or low, we do not cut the sphincter.
If pressure is high, we add partial sphincterotomy to minimize recurrence without causing incontinence.
Does Anal Fissure Surgery Painful?
With our technique, postoperative pain is minimal. Most patients report significant relief compared to pre-operative pain levels in post-op days.
Before Anal Fissure Surgery
Patients should:
- Eat soft, non-spicy foods for a few days prior
- Avoid small-seeded fruits/vegetables
- Stop eating and drinking 6–8 hours before surgery
After Anal Fissure Surgery
Patients are discharged the same day and resume normal activities in a few days. Full healing may take several weeks. To reduce pain and prevent constipation:
- Eat a balanced diet
- Continue warm sitz baths for 15 days
- Avoid straining
What Helps an Anal Fissure?
- Eat fiber: Fruits, vegetables, whole grains
- Drink plenty of water: 2–3 liters/day
- Warm sitz baths: 2–3 times daily
- Don’t delay bowel movements
- Stay active: Walking helps bowel function
- Avoid irritants: Spicy, acidic foods
- Use prescribed creams
Seek medical attention promptly if symptoms persist.
FAQ
What does an anal fissure look like?
A small but deep tear near the anal opening; sometimes with a skin tag.
Where does the pain radiate?
Pain may spread to the tailbone or groin.
What should patients with anal fissures avoid?
Constipation, straining, dehydration, and spicy foods.
Who gets anal fissures?
Common in those with constipation, postpartum women, people with diarrhea, and those who sit for long periods.
How do you know if you have an anal fissure?
Sharp, burning, “glass-cut” pain during defecation, often with bright red bleeding.
Do anal fissures heal?
Acute fissures often heal with treatment; chronic fissures may need surgery.
Difference between anal fissure and hemorrhoids?
Fissure pain is sharp and prolonged; hemorrhoids cause swelling and pressure.
Do fissures recur?
Yes, especially if constipation persists.
Is olive oil helpful?
Not medically proven; may offer temporary relief only.
Can fissures heal on their own?
Acute fissures may heal spontaneously; chronic fissures usually do not.
Is St. John’s wort oil beneficial?
Not medically proven; may be used cautiously as supportive care.
How do you know a fissure is healing?
Pain and bleeding resolve; the tear closes.
How long does healing take?
1–2 weeks for acute fissures; chronic fissures may take months.
Does garlic help?
No—garlic is irritating and should not be used.
Does petroleum jelly help?
It reduces friction but does not cure the fissure.
What should fissure patients avoid eating?
Spicy, acidic foods and low-fiber, constipating foods.
Which doctor treats anal fissures?
A general surgeon or colorectal surgeon.
