What Are Anal Fissures?

Types of Anal Fissures
Healing Time: Acute vs. Chronic Anal Fissures
- Acute anal fissures last less than six weeks.
- Chronic anal fissures last more than six weeks.
Location: Primary vs. Secondary Anal Fissures
- Primary anal fissures are the most common, and they occur at the back or front of the anal opening.
- Secondary anal fissures are those that happen in any other location in the anus other than a primary fissure, such as the side of the anal opening.
Signs and Symptoms of Anal Fissures
- Sharp pain while passing a bowel movement
- Burning or itching during bowel movements
- Radiating pain in the buttocks, upper thighs, or lower back
- Lingering anal pain after passing a bowel movement (up to several hours)
- Bright red bleeding in your stool or on toilet paper
- A visible tear in the skin of the anus
- A small lump near the fissure
- Anal muscle spasms
Causes and Risk Factors of Anal Fissures
- Constipation
- Straining while passing a bowel movement
- Passing large, hard stools
- Chronic diarrhea
- Anal intercourse or penetration
- Childbirth
- Inflammatory bowel disease, such as Crohn’s disease
- Anal cancer
- HIV/AIDS
- Pregnancy
- Tuberculosis
- Obstructed defecation syndrome (a disorder that makes it difficult to pass bowel movements)
- Prior surgery in the area
- Sexually transmitted infections (STIs)
- Diaper rash
- Not eating enough fiber
How Are Anal Fissures Diagnosed?
- Anoscopy This office-based test helps a provider view the rectum and internal anus.
- Flexible Sigmoidoscopy Flexible sigmoidoscopy allows a provider to see the bottom portion of the colon (large intestine).
- Colonoscopy This test helps a provider view the entire colon. A colonoscopy typically requires a full prep and is performed under anesthesia.
Treatment and Medication Options for Anal Fissures
Self-Care
- Soak your anus in warm water several times a day for 10 to 20 minutes each time, either in a bath or a smaller container you can sit in. The water should only cover the buttocks and hips. This is sometimes called a sitz bath. Try to do this after bowel movements.
- For infants, change their diaper often, washing the area gently with each change.
- After passing a bowel movement, use a bidet or clean yourself thoroughly in the shower.
Medication Options
If home remedies don’t heal an anal fissure, you may need a prescription or over-the-counter cream or medication.
- Nitroglycerin (Rectiv)
- Topical nifedipine
- Lidocaine (Xylocaine)
- Petroleum jelly (Vaseline)
- Zinc oxide (Desitin)
- 1 percent hydrocortisone cream (Cortizone)
- Phenylephrine (Preparation H)
- Psyllium (Metamucil)
- Magnesium hydroxide (milk of magnesia)
- Polyethylene glycol (MiraLax)
- Docusate sodium (Colace)
- Mineral oil
- Magnesium citrate (Citroma)
Before you try any over-the-counter medications to treat your anal fissures, be sure to tell your healthcare provider first.
Surgery
Prevention of Anal Fissures
Lifestyle Changes for Anal Fissures
As mentioned, certain lifestyle changes may help you prevent anal fissures.
Make Dietary Changes
Exercise Regularly
Treat Chronic Conditions
How Long Do Anal Fissures Last?
Complications of Anal Fissures
- Slow or incomplete healing
- Anal muscle tension
- Anal spasms
- Repeated fissures
- Tearing that extends to anal muscles
- Severe constipation and fecal impaction
- Anal narrowing (stenosis)
- Anal fistula (tunnel from the inside of the anus to the outer skin)
- Fecal incontinence
- Infection
The best way to avoid these complications is by following your treatment plan and telling your provider about any new symptoms you’re having.
Research and Statistics: Who Has Anal Fissures?
Related Conditions
- Hemorrhoids
- Perianal abscess (pocket of infection)
- Anal fistulas
- Certain STIs
- Inflammatory bowel disease
- Tuberculosis
The Takeaway
- An anal fissure is a small tear in the thin lining of the anus, which causes symptoms like sharp pain and bleeding during and after passing a bowel movement.
- Anal fissures are caused by trauma to the anus, typically from straining to pass large or hard bowel movements.
- You can treat anal fissures with home remedies to help with the pain and spasms, as well as dietary changes to reduce constipation, but sometimes medications or surgery are needed.
- If you experience symptoms of an anal fissure, let your healthcare provider know. They can help you understand what’s going on and what you can do to recover.
Common Questions & Answers
You can treat anal fissures by cleaning yourself well with wipes after each bowel movement, using a bidet, soaking in water, or taking a shower. If these approaches don’t work, your provider may recommend medical or surgical treatments.
An anal fissure looks like a small cut in your anal area. You may have an anal fissure if you feel sharp pain with bowel movements or if you see bright red blood in your stool or on toilet paper.
Many anal fissures heal on their own. If they don’t, you can ask your provider about other treatments.
The main cause of anal fissures is trauma to the anus. This could be due to penetration or a chronic illness, but it happens most often because of constipation.
Resources We Trust
- Mayo Clinic: Anal Fissure
- Cleveland Clinic: Anal Fissures
- American Society of Colon & Rectal Surgeons: Anal Fissure
- Johns Hopkins Medicine: Anal Fissures
- Cedars-Sinai: Anal Fissures
- Anal Fissures. Cleveland Clinic. April 25, 2023.
- Jahnny B et al. Anal Fissures. StatPearls. November 14, 2022.
- Anal Fissure: Symptoms and Causes. Mayo Clinic. December 31, 2024.
- Anal Fissures. Johns Hopkins University.
- Anal Fissure: Diagnosis and Treatment. Mayo Clinic. December 31, 2024.
- Anal Fissure. MedlinePlus. May 29, 2024.
- Anal Fissure. Washington University in St. Louis.
- Water: How Much Should You Drink Every Day? Mayo Clinic. October 12, 2022.
- Common Causes of Constipation. Harvard Health Publishing. July 18, 2023.
- Physical Activity Guidelines for Americans, 2nd Edition. U.S. Department of Health and Human Services. 2018.
- Relieving Constipation With Diet and Exercise. Allied Digestive Health. February 29, 2024.

Yuying Luo, MD
Medical Reviewer
Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.
Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.
She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

Abby McCoy, RN
Author
Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.
McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.