Anal Fissures: What You Need to Know About This Common Cause of Rectal Bleeding

An anal fissure is an injury to the lining of the anal canal. The anus is a short tube at the end of the rectum and is the final stop as stool leaves the body. The anus is surrounded by muscles that allow you to control when you have a bowel movement. 

Anal fissures can occur in anyone. They’re a common cause of pain and bleeding with bowel movements. That's why people sometimes confuse anal fissures with other medical conditions, especially hemorrhoids. But a trained medical provider will be able to diagnose anal fissures with a physical exam. A proper diagnosis is key because the treatment for an anal fissure can be simple and very effective. 

What can cause an anal fissure?

Anal fissures most commonly occur when you’re constipated. Large, hard, or dry stools can injure the anus while passing through. Fissures can also occur from diarrhea. Frequent, loose stools that pass with force can damage the anal canal and lead to a fissure. 

Other causes of anal fissure can include:

• Anal trauma

• Inflammatory bowel disease

• Infections

• Cancer

The condition of the surrounding muscles of the anus may also be a factor. If those muscles are too tight or unable to relax during a bowel movement, you can develop an anal fissure.

What are the symptoms of an anal fissure? 

Anal pain is one of the most common symptoms of an anal fissure. This pain will frequently occur during a bowel movement, but you may feel it at other times too. 

You may also notice blood when wiping after a bowel movement. This can sometimes make it difficult to know whether you have an anal fissure or hemorrhoids. 

If you’re having rectal bleeding, your provider will evaluate you to make the proper diagnosis.

How do you diagnose anal fissures?

The diagnosis of anal fissure is a relatively simple process. Your healthcare provider will talk with you about your bowel movements. Don’t be embarrassed to provide details about your bowel or sexual habits. This information can be very helpful for your medical care. 

Your provider will perform a physical examination. They’ll visually check the anal region for split or torn tissue. They’ll also likely do a rectal exam. This is where a provider briefly places a gloved finger in the anal canal and rectum. 

In some cases, your provider may suggest that you have a colonoscopy or flexible sigmoidoscopy to have a closer look.

What is the difference between anal fissures and hemorrhoids? 

Hemorrhoids are enlarged, inflamed blood vessels in and around the anus. While anal fissures can bleed, hemorrhoids will typically have much more bleeding. Your healthcare provider will do a thorough exam to make the proper diagnosis. 

How do you treat anal fissures?

After an anal fissure diagnosis, you and your provider will work together to create a treatment plan. We’ll go over the main treatment options here.

Dietary changes

If you have anal fissures, you could likely benefit from more fiber. The average American eats about 16 grams of fiber daily. This is well below the recommended amount. Increasing your fiber to 25 to 35 grams per day will improve both constipation and diarrhea. And this will help improve anal fissure symptoms. 

Many foods have fiber, such as different types of fruits and vegetables. There’s also fiber in nuts, beans, and whole grains.

Dehydration can also worsen constipation. So increasing your water intake can help to manage anal fissures due to hard stools. Your provider may suggest increasing your water intake to help soften your stools. There are no rules on how much water you should drink each day. It will differ for everyone. Check with your provider for guidance on how much you should be drinking.

Sitz baths

A sitz bath is a nice and simple way to help decrease the uncomfortable symptoms of an anal fissure. To take a sitz bath, you simply soak your bottom in warm water for about 10 to 15 minutes. You can do this in a bathtub or small, plastic tub that you can get from the pharmacy. 

You can take a sitz bath multiple times a day or as needed to improve any symptoms you may be having. Warm water alone can help, or you can use additives like Epsom salt.

Medications

Your healthcare provider may recommend stool softeners (for constipation) and topical ointments. Topical ointments (like nitroglycerin) can help fissures heal by relaxing the muscles of the anus. You can use ointments multiple times a day, or as your provider recommends.

Surgical options

If nonsurgical management doesn't help your symptoms, your provider may refer you to a surgeon. Surgical treatments to heal anal fissures may include:

• Botox injection: Botox around the anus can help relax the muscles around the anus. 

• Internal anal sphincterotomy: This is a procedure to cut a small portion of the muscles around the anus. 

How long does it take for anal fissures to heal? 

Complete recovery from anal fissures takes about 6 to 12 weeks on average. Although you may start to feel better quickly, it’s important to continue your treatment plan. That’s because anal fissures often come back. This is especially true if you stop treatment early.

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Written by:

Valerie Emuakhagbon, MD

Valerie Emuakhagbon, MD, is a board-certified colorectal surgeon. A native of Dallas, Texas, she completed the six-year BA/MD program at the University of Missouri-Kansas City.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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