Anal fissures: causes, symptoms, treatment and how to prevent them

An anal fissure is a small tear or crack in the lining of the anus. It can be surprisingly painful, especially during and after a bowel movement. Many people describe the pain as sharp, cutting, burning or even like passing broken glass. Bright red blood on toilet paper or on the surface of the stool is also common.

The good news is that most acute anal fissures heal with simple measures that make bowel movements softer and reduce irritation. However, fissures that keep coming back or do not heal may become chronic and require prescription medicines or other treatment.

An anal fissure is often associated with constipation and passing hard stools, but chronic diarrhea, childbirth, local injury and certain inflammatory or infectious conditions can also cause one.

What causes anal fissures?

The most common cause is trauma to the delicate lining of the anal canal. This often happens when a person passes a large or hard stool or strains heavily during a bowel movement.

Other possible causes include:

• Chronic constipation
• Passing hard or bulky stools
• Repeated straining during bowel movements
• Long-lasting diarrhea
• A low-fibre diet that contributes to constipation
• Childbirth, particularly vaginal delivery
• Anal injury or trauma
• Anal intercourse
• Inflammation around the anus
• Inflammatory bowel disease such as Crohn’s disease
• Certain infections
• Previous anorectal surgery

In some cases, an anal fissure can occur because of an underlying medical condition. Fissures that are multiple, occur away from the usual front or back midline locations, or repeatedly fail to heal deserve medical evaluation.

What are the first signs of an anal fissure?

The classic symptom is sharp pain during a bowel movement. The pain may continue for minutes or several hours afterward because the anal sphincter can go into spasm.

Other common signs include:

• Bright red blood on toilet paper
• A small amount of blood on the outside of the stool
• Burning or itching around the anus
• A visible crack near the anal opening
• Anal muscle spasms
• A small skin tag or lump near a chronic fissure
• Fear of passing stool because of the pain

Pain and bright red bleeding are particularly characteristic. However, rectal bleeding should not automatically be assumed to be a fissure because haemorrhoids and other conditions can cause similar symptoms.

Do I have a hemorrhoid or fissure?

Anal fissures and hemorrhoids, commonly called piles, can be confused because both may cause bleeding, itching and discomfort.

A fissure is a tear in the anal lining. The pain is often sharp and closely related to bowel movements. Pain may continue for some time after passing stool.

Hemorrhoids are swollen blood vessels in or around the anus. Internal haemorrhoids commonly cause painless bright red bleeding, while an external haemorrhoid can become painful, particularly when thrombosed.

That said, symptoms overlap, so you cannot reliably diagnose yourself based only on pain or bleeding. A healthcare professional can usually identify a fissure through the history and a gentle examination.

How do you confirm an anal fissure?

Diagnosis is usually clinical. A doctor will ask about your bowel movements, pain, bleeding and other symptoms and then inspect the anal area.

A fissure can often be seen as a small tear. If the area is extremely painful, the examination may be kept very gentle. Additional tests such as anoscopy, sigmoidoscopy or colonoscopy may be considered when the diagnosis is uncertain, symptoms are unusual, or another condition needs to be ruled out.

Do not repeatedly insert a finger into the anus to try to locate a fissure. This can be painful and may further irritate the tear. A healthcare professional can decide whether a digital rectal examination is appropriate.

Can you feel a fissure with your finger?

Usually, you should not try to diagnose a fissure by touching it yourself. A fissure is a tear in the delicate anal lining, and touching the area can cause significant pain or further irritation.

A doctor may be able to identify the fissure during an examination, but even this is sometimes avoided when the pain is severe. If you have persistent anal pain or bleeding, professional examination is safer than self-examination.

How do you heal an anal fissure?

The first goal is to create conditions that allow the tear to heal while preventing another injury during bowel movements.

Important measures include:

Keep stools soft. Increase dietary fibre gradually and drink adequate fluids. Fibre can help produce softer, easier-to-pass stools.

Avoid straining. Sitting on the toilet for long periods and repeatedly pushing hard can increase pressure on the anal area.

Take warm baths. A warm-water sitz bath for around 10 to 20 minutes can relax the anal sphincter and provide relief, particularly after bowel movements.

Treat constipation promptly. Your doctor may recommend a fibre supplement or stool-softening medicine when necessary.

Keep the area clean without excessive rubbing. Gentle washing is preferable to aggressive wiping.

Acute fissures often heal within several weeks with appropriate conservative treatment.

What is the fastest way to heal a fissure?

There is no single instant cure, but the fastest approach is usually to stop the cycle of hard stools, straining, tearing and sphincter spasm.

A practical approach is to:

1. Keep stools soft with adequate fibre and fluids.
2. Avoid straining.
3. Take warm sitz baths.
4. Follow any prescribed medicines correctly.
5. Seek medical advice if symptoms persist or are severe.

For chronic fissures, doctors may prescribe medicines that relax the anal sphincter, such as topical nitroglycerin or calcium-channel blockers. Botox injections may be considered in some patients. Persistent fissures may require a surgical procedure called lateral internal sphincterotomy.

Does an anal fissure heal automatically?

Yes, many acute fissures heal on their own, particularly when constipation or diarrhoea is corrected. Cleveland Clinic notes that most fissures heal with self-care, while Johns Hopkins reports that acute fissures typically heal within about six weeks with conservative treatment.

However, “wait and see” does not mean ignoring symptoms indefinitely. If pain or bleeding continues, keeps returning, or is causing you to avoid bowel movements, speak with a healthcare professional.

What happens if a fissure is left untreated?

An untreated fissure may heal naturally, but it can also become chronic.

Repeated trauma and spasm of the internal anal sphincter can create a cycle in which the fissure repeatedly opens every time stool passes. Over time, the edges may become thicker and a small skin tag, sometimes called a sentinel tag, may develop.

Chronic fissures may require prescription treatment or a procedure to relax the sphincter and allow healing.

So, while an anal fissure is usually not dangerous, persistent symptoms should not be ignored.

Is an anal fissure serious?

Most anal fissures are not life-threatening or dangerous, and many respond well to conservative treatment.

However, a fissure can become a significant problem when it is chronic, repeatedly recurring or associated with another underlying condition. Persistent rectal bleeding also deserves evaluation because not every episode of bleeding is caused by a fissure.

Is a fissure worse than piles?

Neither condition is automatically “worse.” They are different problems.

A fissure often causes more intense pain during and after bowel movements, whereas haemorrhoids may cause bleeding, itching, swelling or a lump and may sometimes be painless.

The severity depends on the individual condition. A thrombosed external haemorrhoid can be extremely painful, while a chronic fissure can cause recurring pain and difficulty passing stool.

Can a fissure be cancerous?

An ordinary anal fissure is not cancer and does not normally turn into cancer.

However, certain cancers and other diseases can sometimes produce symptoms that resemble a fissure. Atypical, non-healing, multiple or off-midline fissures may therefore require additional investigation. Anal cancer is listed among the less common conditions associated with fissure-like lesions.

This is one reason persistent bleeding or a fissure that does not heal should be assessed by a doctor rather than repeatedly treated at home.

Can I still poop with a fissure?

Yes. In fact, avoiding bowel movements because of the pain can make constipation worse and potentially prolong the problem.

The aim is to make bowel movements as soft and easy as possible. Drink enough fluids, consume adequate fibre and avoid straining. If constipation is significant, ask a healthcare professional whether a fibre supplement or stool-softening medicine would be appropriate.

Try not to delay the urge to pass stool for long periods.

How should you poop if you have a fissure?

The goal is a soft, easy bowel movement rather than forcing stool out.

Try these habits:

• Go when you feel the urge.
• Avoid prolonged sitting on the toilet.
• Do not strain excessively.
• Keep your fluid intake adequate.
• Eat enough fibre.
• Consider a footstool to raise your feet slightly if that makes bowel movements easier.
• Take a warm bath afterward if it provides relief.

If passing stool remains extremely painful, talk to a doctor rather than repeatedly forcing yourself through severe pain.

Is lady finger good for fissures?

Lady finger, also known as okra, can be included in a diet for people with anal fissures. It provides dietary fibre and can contribute to softer, more regular stools.

However, okra is not a cure for an anal fissure. The overall dietary pattern matters more than one particular vegetable. Fibre should also be increased gradually, especially if your current diet is low in fibre, because suddenly eating a large amount can cause bloating or discomfort.

What foods should I avoid with fissures?

There is no universal “fissure diet,” but some foods or eating habits can make symptoms worse indirectly by contributing to constipation or, in some people, irritation.

Consider limiting:

• Highly processed, low-fibre foods
• Large amounts of refined carbohydrates
• Foods that contribute to constipation for you personally
• Excessive alcohol if it contributes to dehydration or bowel changes
• Very spicy foods if they worsen burning or discomfort

Johns Hopkins specifically advises avoiding spicy foods while an anal fissure is active if they aggravate symptoms.

The bigger priority is usually adequate fibre, fluids and regular bowel habits, rather than following a highly restrictive diet.

Which fruit is not good for fissures?

There is no fruit that everyone with an anal fissure needs to avoid.

Fruits such as papaya, pears, oranges, apples and berries can contribute fibre and fluids to the diet. The important thing is how your body responds and whether the overall diet helps maintain soft stools.

If a particular fruit causes diarrhoea, bloating or constipation for you, reduce it temporarily. Eating large quantities of any food simply because it is labelled as “good for fissures” is unnecessary.

Which drink is good for fissures?

Water is the most important drink. Adequate hydration supports softer stools, particularly when you increase your fibre intake.

Warm water or other non-irritating fluids can also be included as part of a balanced diet. There is no special juice or drink proven to cure an anal fissure.

If you have a medical condition that requires fluid restriction, follow your doctor’s advice instead of increasing fluids on your own.

How can you cure fissures permanently?

There is no guarantee that a fissure can never return, but recurrence can often be reduced.

The most important long-term habits are:

• Prevent constipation.
• Maintain adequate dietary fibre.
• Drink enough fluids.
• Avoid excessive straining.
• Keep bowel movements regular.
• Treat persistent diarrhoea.
• Address underlying inflammatory or bowel conditions.
• Follow prescribed treatment for chronic fissures.

Fibre maintenance after healing can help reduce recurrence.

If fissures repeatedly return despite good bowel habits, a doctor should look for contributing factors rather than simply treating each episode separately.

How did I cure my fissure naturally?

Many people do recover from an acute fissure without surgery. Natural or home-based measures that may support healing include improving fibre intake, drinking adequate fluids, avoiding straining and taking warm sitz baths.

However, there is an important distinction between supporting natural healing and claiming that a particular home remedy cures every fissure.

A fissure that is chronic or repeatedly recurring may need prescription treatment. Trying multiple home remedies while postponing medical evaluation can allow a treatable fissure to become more difficult to manage.

Will a fissure turn into a fistula?

A fissure and fistula are different conditions.

An anal fissure is a tear, whereas an anal fistula is an abnormal tunnel between the anal canal and nearby skin. Anal fistulas are more commonly associated with an infection or abscess around the anus.

A fissure should not routinely be expected to become a fistula. If you develop swelling, increasing constant pain, fever or pus-like drainage near the anus, you should seek medical attention because these symptoms can suggest an abscess or fistula rather than a straightforward fissure.

What are the first signs of a fistula?

Possible signs of an anal fistula include:

• Persistent drainage or pus from an opening near the anus
• Recurrent swelling in the same area
• A painful lump that may burst and drain
• Skin irritation around the opening
• Recurrent perianal abscesses
• Occasionally, bleeding or discomfort

These symptoms are different from the classic pattern of a fissure, which is typically a painful tear associated with bowel movements.

Is a fistula 100% curable?

Anal fistulas are treatable, but no responsible medical source should promise a 100% cure for every patient.

Treatment depends on the fistula’s location, complexity and relationship to the anal sphincter. Many require a surgical procedure, and some complex fistulas need staged or specialised treatment.

If you suspect a fistula, a colorectal surgeon or other appropriately trained healthcare professional can determine the best treatment.

How can you avoid anal fissures permanently?

No prevention strategy can guarantee that you will never develop another fissure. However, maintaining healthy bowel habits can significantly reduce the risk.

Focus on:

• Eating enough fibre
• Drinking adequate fluids
• Preventing constipation
• Avoiding repeated straining
• Treating diarrhoea appropriately
• Exercising regularly
• Responding promptly to changes in bowel habits
• Seeking treatment for recurrent fissures

Mayo Clinic recommends fibre, fluids and regular physical activity as part of fissure prevention.

When should you see a doctor?

See a healthcare professional if you have rectal bleeding, significant pain during bowel movements, symptoms that keep returning, or pain severe enough that you are avoiding the toilet.

Medical evaluation is particularly important when:

• Bleeding is persistent or heavy
• The fissure does not heal
• The fissure keeps coming back
• The tear appears away from the usual front or back position
• There are multiple fissures
• You have unexplained weight loss or changes in bowel habits
• You develop fever, swelling or pus-like drainage
• You have a condition such as inflammatory bowel disease

Persistent or unusual symptoms may require investigation for another underlying condition.

Frequently asked questions about anal fissures

Can an anal fissure heal without surgery?

Yes. Many acute fissures heal with measures such as adequate fibre and fluids, stool-softening strategies, avoiding straining and warm sitz baths. Chronic fissures may need medicines, Botox or surgery.

How long does an anal fissure take to heal?

Many acute fissures improve within days to several weeks. A fissure that persists for several weeks or does not respond to conservative care should be evaluated. Chronic fissures may require several weeks of medical treatment.

Is bright red blood always caused by a fissure?

No. Bright red blood can occur with fissures and haemorrhoids, among other causes. Persistent or unexplained rectal bleeding should be evaluated.

Can constipation cause an anal fissure?

Yes. Constipation, hard stools and straining are among the most common causes of anal fissures.

Can diarrhoea cause an anal fissure?

Yes. Repeated diarrhoea can irritate and damage the anal lining and is a recognised cause of fissures.

What is commonly mistaken for an anal fissure?

Haemorrhoids are a common alternative diagnosis. Other possibilities include perianal abscesses, fistulas, inflammatory bowel disease, infections and, less commonly, malignancy.

Is a fissure a serious problem?

Usually, no. Most are benign and treatable. The problem becomes more significant when a fissure becomes chronic, repeatedly recurs or is actually a sign of another condition.

What is the difference between a fissure and a fistula?

A fissure is a tear in the anal lining. A fistula is an abnormal tunnel connecting the anal canal or rectum with the skin. They are separate conditions and require different treatments.

Can I prevent another fissure after it heals?

You can reduce the risk by keeping stools soft, eating adequate fibre, staying hydrated, avoiding straining and treating constipation or diarrhoea promptly.

Is there a permanent natural cure for fissures?

Some acute fissures heal naturally with bowel-habit and lifestyle changes. However, there is no natural remedy that guarantees permanent healing for every fissure. Chronic or recurrent fissures should be medically assessed.

Final thoughts

An anal fissure can be extremely uncomfortable, but it is usually a manageable condition. The key is to break the cycle of hard stools, straining, pain and repeated tearing.

For many people, adequate fibre and fluids, regular bowel habits and warm sitz baths are enough to allow an acute fissure to heal. If symptoms persist, prescription medicines and other treatments can help. Chronic fissures should not simply be tolerated indefinitely.

Most importantly, do not assume that every episode of anal pain or rectal bleeding is a fissure. Haemorrhoids, abscesses, fistulas, inflammatory bowel disease and other conditions can produce similar symptoms. Getting the correct diagnosis is the first step toward effective treatment.

Medical disclaimer: This article is intended for general health education and does not replace an examination or personalised medical advice. If you have persistent anal pain, rectal bleeding, fever, swelling, pus-like drainage or a non-healing lesion, consult a qualified healthcare professional.

Sources for further reading:
Cleveland Clinic – Anal Fissures
Mayo Clinic – Anal fissure
Johns Hopkins Medicine – Anal Fissures
NCBI Bookshelf – Anal Fissures
NHS – Anal fissure