Anal Fissure: What You Should Know About Symptoms, Causes and Treatment

An anal fissure is a small tear in the lining of the anal canal that can cause significant discomfort. Although common, fissures are often confused with hemorrhoids because both conditions can cause pain and bleeding during bowel movements. According to the American Society of Colon and Rectal Surgeons (ASCRS), fissures can affect people of all ages and are usually caused by trauma to the anal canal.

The most common symptoms include sharp pain during or after bowel movements, bright red blood on toilet paper or stool, and muscle spasms around the anus. In chronic cases, patients may also notice a small skin tag or lump near the fissure. Many people become anxious about bowel movements because the pain can last from several minutes to a few hours afterward.

Constipation and passing hard, dry stools are among the leading causes of anal fissures. However, diarrhea and frequent loose stools can also irritate the area and contribute to tearing. Tight anal sphincter muscles may reduce blood flow to the area, making healing more difficult.

Fortunately, most anal fissures improve without surgery. Treatment often focuses on reducing strain during bowel movements and promoting healing. Doctors commonly recommend increasing fiber intake to 25–35 grams per day, drinking more water, using stool softeners if needed, and soaking in warm sitz baths. Topical medications may also help relieve pain and relax the anal muscles.

For chronic fissures that do not heal with conservative treatment, additional options may include Botox® injections or a surgical procedure called lateral internal sphincterotomy (LIS). ASCRS reports that LIS surgery has a success rate of more than 90% in appropriately selected patients.

If symptoms persist or repeatedly return, it is important to seek medical evaluation. Other conditions, including inflammatory bowel disease or infections, can sometimes mimic the symptoms of an anal fissure. Early diagnosis and treatment can help reduce pain, improve healing, and prevent complications.