Anal fissures
A painful little tear that can cause a lot of drama — here’s how to spot an anal fissure, soothe the pain, and help it heal.
Fast, discreet support for anal fissure symptoms, with clear advice on what helps (and what makes it worse).
Treatment options explained in plain English, plus red flags so you know when to get checked urgently.
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What you should know about anal fissures
An anal fissure is a small tear in the lining of the anal canal. It often feels like a sharp, burning pain during (and after) a poo, and you might notice a small amount of bright red blood.
It can happen after passing a hard stool, but it’s not always constipation. Some fissures start after diarrhoea or irritation, and sometimes there’s no obvious trigger.
Fissures usually cause sharp “paper cut” pain, often with a streak of bright red blood. Piles (haemorrhoids) are more likely to cause itching, swelling, or bleeding with less sharp pain. If you’re not sure, it’s worth getting checked.
Many improve within a few weeks, especially if stools are kept soft and you avoid straining. If symptoms last longer than about 6–8 weeks, it may be classed as chronic and can need targeted treatment.
Keep stools soft and easy to pass: drink enough fluids, increase fibre gradually, and don’t strain or “hover” on the toilet. Warm baths can help relax the area and ease discomfort.
Treatment depends on how long it’s been going on and how severe the symptoms are. Options can include stool softeners, pain relief, and prescription creams/ointments that relax the internal anal sphincter (to improve blood flow and reduce pain). Some people may need specialist treatments if it doesn’t settle.
Get urgent help if you have heavy bleeding, severe worsening pain, fever, pus, a new lump, or you feel unwell. Also get checked if bleeding is persistent, symptoms keep coming back, or you have unexplained weight loss or a change in bowel habit.
Yes, it can. The most common reason is the same trigger that caused it in the first place — usually hard stools, straining, or repeated irritation. The best way to reduce the chance of it returning is to keep stools soft long-term (steady fibre, good hydration, and not delaying the toilet), and to act early if symptoms start again. If fissures keep recurring, it’s worth a proper review to check for an underlying cause and to discuss longer-term treatment options.
Additional information
Anal Fissures
Understanding anal fissures and how to manage them effectively. This guide covers everything you need to know about this common condition—from what causes it to the best treatment options available. Whether you’re experiencing symptoms or looking to prevent them, we’ll walk you through the facts, treatments, and practical tips to help you feel better.
Key takeaways
- An anal fissure is a small tear in the skin inside your anus that causes pain during bowel movements
- They’re incredibly common and usually heal within 6-8 weeks with the right care
- Most cases improve with simple lifestyle changes like eating more fibre and staying hydrated
- Medical treatments like GTN ointment or calcium-channel blocker creams can speed up healing
- If symptoms persist beyond 8 weeks, your GP can refer you to a specialist for advanced options
What is an anal fissure?
An anal fissure is a small tear or open sore in the skin just inside your anus. Think of it like a paper cut, but in a much more sensitive area. When you have a fissure, you’ll typically feel sharp pain during and after bowel movements, and you might notice a bit of bleeding [1].
The good news? Most anal fissures heal on their own within 6-8 weeks. But they can be pretty uncomfortable while they’re healing, so understanding what’s happening and what you can do about it makes a real difference.
How common are anal fissures?
Anal fissures are more common than you might think. They affect people of all ages, though they’re slightly more common in younger adults. You’d be surprised how many people deal with anal fissures. About 1 in 350 adults will have one, and every year, roughly 1 in 1,000 people develop one for the first time [2]. So, if you’re experiencing one, you’re definitely not alone—thousands of people deal with this every year in the UK.
The condition doesn’t discriminate. It can happen to anyone, whether you’re generally healthy or managing other health conditions. Pregnancy and childbirth increase the risk, as do certain digestive conditions, but constipation is by far the most common trigger.
What causes anal fissures?
Understanding what causes your fissure is the first step to preventing it from happening again.
Hard or painful bowel movements are the main culprit. When you strain to pass a hard stool, the muscles around your anus tense up and spasm. This tightening reduces blood flow to the area, making the skin more fragile and prone to tearing [1].
Other common causes include:
- Constipation—hard stools are the biggest risk factor
- Pregnancy and childbirth—the pressure on your perineum (the area between your anus and genitals) can cause tears
- Inflammatory bowel disease, like Crohn’s disease
- Sexually transmitted infections or skin infections
- Skin conditions such as psoriasis or eczema
- Certain medicines that cause constipation, like opioid painkillers or some chemotherapy drugs
- Trauma to the area from anal sex or surgery
- Rarely, bowel cancer
The key point? Most of these causes come down to either constipation or physical trauma. By managing your bowel health and preventing constipation, you can significantly reduce your risk.
What happens in your body with an anal fissure?
When you develop an anal fissure, a few things happen at once. The tear itself is painful because the area around your anus is packed with nerve endings. Every time you have a bowel movement, the fissure stretches, triggering that sharp, searing pain you might experience.
The muscles around your anus (called the internal and external sphincters) naturally tighten in response to pain. This is your body’s protective reflex, but it’s actually counterproductive. The tightening reduces blood flow to the area, slowing healing. It’s a bit of a vicious cycle—pain causes muscle tension, which reduces blood flow, which means the fissure takes longer to heal [3]
This is why treatments like GTN ointment work so well. They relax these muscles, improve blood flow, and give your body a better chance to heal itself [4].
Recognising the symptoms of anal fissures
If you have an anal fissure, you’ll likely notice symptoms that get worse after a bowel movement.
The main symptoms include:
- Sharp, searing, or burning pain in or around your bottom during and after bowel movements
- A deep, burning pain that can last for several hours after you’ve been to the toilet
- Visible bleeding from your anus—you might see blood in the toilet or on the toilet paper
- Sudden muscle spasms (tightening) around your anus when you poo
- A visible tear or crack in the skin around your anus
It’s worth noting that other conditions can cause similar symptoms. Piles (haemorrhoids), for example, also cause pain and bleeding. This is why it’s important to see your GP if you’re experiencing these symptoms, especially if there’s bleeding involved.
How are anal fissures diagnosed?
Your GP can usually diagnose an anal fissure pretty straightforwardly. They’ll ask you about your symptoms, then perform a gentle physical examination.
During the examination, your doctor will ask you to lie on your side with your knees bent towards your chest. They’ll gently part your buttocks to look at the area. Most of the time, they can see the fissure directly, which confirms the diagnosis.
If there’s any uncertainty about what’s causing your symptoms, or if initial treatments don’t help, your GP might refer you to a colorectal surgeon—a specialist who focuses on conditions affecting your bowel and back passage. They can do more detailed investigations if needed.
Can anal fissures be cured?
Yes, anal fissures can absolutely be cured. Most heal completely within 6-8 weeks with proper care. The key is preventing constipation and giving your body the conditions it needs to heal.
As your fissure heals, you’ll notice your pain gradually lessening and any bleeding stopping. Your GP will usually want to see you for a follow-up appointment after 6-8 weeks to confirm that everything’s healed properly.
The important thing to remember is that healing takes time. You won’t feel better overnight, but with the right approach, you will get better.
Self-help strategies that actually work
Before reaching for medicines, there are several things you can do at home that make a real difference.
Eating for better bowel health
Fibre is your best friend when it comes to anal fissures. A high-fibre diet keeps your stools soft and easier to pass, which means less strain and less pain.
Aim for about 30g of fibre per day. You can get this from:
- Wholegrain bread, rice, and pasta
- Oats and other cereals
- Beans and lentils
- Fruit (especially with the skin on)
- Vegetables (fresh or frozen)
Increase your fibre gradually though. Jump in too quickly and you might get bloating or wind, which isn’t pleasant.
Staying hydrated
Drinking enough water is just as important as eating fibre. Aim for about 6-8 glasses of water a day. Proper hydration keeps your stools soft and makes them easier to pass.
Getting to the toilet on time
Because anal fissures hurt, you might be tempted to delay going to the toilet. Don’t. The longer you wait, the more water gets reabsorbed from your stool, making it harder and more painful to pass. Go when you feel the urge, and try not to strain.
Keeping the area clean and dry
Gentle hygiene is important. After a bowel movement, clean the area gently with water. Pat it dry carefully—don’t rub. If you find toilet paper irritating, try using a bidet or a damp cloth instead.
Warm baths for pain relief
Sitting in a warm bath after a bowel movement can really help with pain relief. The warmth relaxes the muscles around your anus and improves blood flow. Aim for about 10-15 minutes in comfortably warm water.
Over-the-counter pain relief
Paracetamol or ibuprofen can help manage the pain while your fissure heals. Just make sure you read the patient information leaflet and follow the dosage instructions.
Medical treatments for anal fissures
If self-help measures aren’t cutting it, or if your pain is severe, your GP can prescribe several effective treatments.
Laxatives and stool softeners
If constipation is the problem, your GP might suggest laxatives or stool softeners like ispaghula husk or lactulose. These work by adding bulk to your stool or drawing water into it, making it softer and easier to pass. You can buy many of these over the counter from any pharmacy.
Anaesthetic ointments
Your GP can prescribe anaesthetic ointments, such as lidocaine. You apply these to your anus before a bowel movement to numb the area and reduce pain. They work quickly but only provide temporary relief [4].
Glyceryl trinitrate (GTN) ointment
GTN ointment, such as Rectogesic, is one of the most effective treatments for anal fissures. It works by relaxing the muscles around your anus and improving blood flow to the area, which helps your fissure heal faster. You’ll need to use it for about 6-8 weeks, and it’s quite effective—around 50-70% of people see their fissure heal with GTN treatment [4].
It’s not suitable for children or pregnant women, and some people experience headaches as a side effect, but for most people it’s a game-changer.
Calcium-channel blocker creams
Diltiazem cream is another option that works similarly to GTN ointment—it relaxes the muscles and improves blood flow. The bonus? It tends to have fewer side effects than GTN, so it might be a better option if you experience headaches.
Advanced treatments for stubborn fissures
If your fissure isn’t healing after 8 weeks of treatment, or if it keeps coming back, your GP will refer you to a colorectal surgeon. They have several options available.
Botox injections
Botox can be injected into the sphincter muscle to temporarily relax it, giving your fissure a chance to heal. It’s a minimally invasive option that works well for some people.
Lateral internal sphincterotomy
This is a surgical procedure where the surgeon carefully cuts a small part of the sphincter muscle to release tension around your anus. It’s quite effective but does carry a small risk of affecting continence, so it’s usually only considered when other options haven’t worked.
Fissurectomy
This involves surgically removing the damaged skin around the fissure. It’s less commonly used these days but can be effective for stubborn cases.
Anal advancement flaps
This is a newer technique where healthy skin from your anal lining is used to replace the damaged skin in your fissure. It’s particularly useful for chronic fissures that keep coming back.
Preventing anal fissures from coming back
Once you’ve dealt with an anal fissure, you’ll want to make sure it doesn’t happen again.
The best prevention strategy is keeping your bowels regular and your stools soft:
- Eat plenty of fibre every day
- Drink enough water
- Exercise regularly—even a 20-minute walk helps
- Don’t ignore the urge to go to the toilet
- Avoid straining
- If you’re taking medicines that cause constipation, talk to your GP about alternatives
If you have a health condition that increases your risk—like Crohn’s disease or irritable bowel syndrome—work with your GP to manage it effectively. Good management of your underlying condition can significantly reduce your fissure risk.
Frequently asked questions
How long does an anal fissure take to heal?
Most anal fissures heal within 6-8 weeks with proper care. Some heal faster, especially if you start treatment early. Chronic fissures that keep coming back might take longer or need specialist treatment.
Is an anal fissure serious?
No, anal fissures aren’t serious in the medical sense. They’re not life-threatening and they don’t lead to other complications. That said, they can be quite painful and affect your quality of life, so it’s worth treating them properly.
Can I pass an anal fissure to someone else?
No, you can’t catch an anal fissure from someone else or pass it on. It’s not contagious. The only exception is if the fissure is caused by an infection—in that case, the infection might be transmissible, but not the fissure itself.
Will my anal fissure come back?
Some people get fissures once and never again. Others are prone to them. If you’re someone who gets them repeatedly, focus on prevention—keep your bowels regular, eat plenty of fibre, and stay hydrated. If you do get another one, you’ll know what to do.
Should I see a doctor about bleeding from my bottom?
Yes, always. While anal fissures are a common cause of bleeding, so are other conditions like piles or, rarely, more serious issues. Your GP needs to check it out to make sure everything’s okay.
Can I exercise with an anal fissure?
You can, but you might want to take it easy while you’re in acute pain. Once the worst of the pain has passed, gentle exercise like walking is actually good for you—it helps prevent constipation, which is key to healing.
What’s the difference between an anal fissure and piles?
Anal fissures are tears in the skin inside your anus. Piles (haemorrhoids) are swollen blood vessels in the same area. They can cause similar symptoms, but they’re different conditions and are treated differently. Your GP can tell you which one you have.
Can pregnancy cause anal fissures?
Yes, pregnancy can increase your risk. The pressure on your perineum during pregnancy and childbirth can cause tears. Constipation, which is common in pregnancy, also increases your risk. If you’re pregnant and develop a fissure, tell your GP—some treatments aren’t suitable during pregnancy.
Are there any foods I should avoid?
Not really avoid, but be mindful of foods that might make constipation worse—things like processed foods, cheese, and foods low in fibre. Focus on adding fibre-rich foods rather than cutting things out.
Can stress make anal fissures worse?
Stress can contribute to digestive issues and constipation, which might make fissures worse. Managing stress through exercise, relaxation, or talking to someone can help your overall bowel health.
Looking to the future
Research into anal fissure treatment is ongoing. New techniques and medicines are being developed to make healing faster and more reliable. If you have a chronic fissure that’s not responding to standard treatments, ask your GP about newer options or clinical trials you might be eligible for.
The key takeaway is that anal fissures are common, treatable, and usually heal well with the right approach. You don’t have to suffer through this alone—your GP and specialist pharmacists can help you find the right treatment plan.
How this content was created
This guide was created by our team of registered pharmacists and healthcare professionals at Medical Mojo. We’ve drawn on the latest clinical guidelines from the NHS and NICE, peer-reviewed research, and real patient experiences to create information that’s both accurate and genuinely helpful.
Every section has been reviewed for medical accuracy and written in plain language so you can understand what’s happening in your body and what your options are. We’ve focused on giving you practical, actionable advice alongside the science—because understanding your condition is the first step to managing it well.
References
[1] NHS (2024) Anal fissure. NHS. Available at: https://www.nhs.uk/conditions/anal-fissure/ (Accessed: 18 February 2026).
[4] NICE (2025) Anal fissure: Goals and outcome measures. NICE Clinical Knowledge Summaries. Available at: https://cks.nice.org.uk/topics/anal-fissure/goals-outcome-measures/ (Accessed: 18 February 2026).
BSc Pharmacy, Independent Prescriber, PgDip Endocrinology, MSc Endocrinology, PgDip Infectious Diseases
Superintendant Pharmacist, Independent Prescriber
MbChB, Coaching Academy diploma with distinction
GP, Medical coach
