Anal Fissure: Causes, Symptoms, and Treatment
Written by Harsha Moole, MD. Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Anal Fissure?
A colon and rectal surgeon (a doctor who treats problems of the bowel and anus) or a gastroenterologist (a stomach and bowel doctor) treats anal fissures. Many people first see their primary care doctor. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is an anal fissure?
An anal fissure is a small tear in the skin that lines the opening of the anus. The anal canal is a short tube surrounded by muscle at the end of the rectum, which is the bottom section of the large intestine. Fissures are common, and people often confuse them with hemorrhoids.
Most fissures happen at the back of the anal opening. Pain and bleeding with bowel movements are the typical signs. Between bowel movements, people are often relatively symptom-free.
Symptoms
Signs of an anal fissure include:
- Sharp pain that starts when stool passes. It can last from several minutes to a few hours.
- Bright red blood on the stool or toilet paper after a bowel movement.
- A small lump or skin tag near the tear. This is more common when a fissure has been there for more than 6 weeks.
Many people fear having a bowel movement and try to avoid it. But avoiding bowel movements makes stools harder and can make the fissure worse.
Causes and who gets it
Fissures are usually caused by trauma to the inner lining of the anus. A hard, dry bowel movement is typically responsible, but loose stools and diarrhea can also cause one. The injury causes pain and spasm of the anal sphincter, the muscle around the anus. The spasm lowers blood flow to the injury and slows healing. The next bowel movement then starts the cycle again.
People with a tight anal sphincter muscle are more likely to get fissures. Fissures are also common in women after childbirth and in people with Crohn disease. They can happen at any age, and they affect males and females equally.
How doctors diagnose it
Your doctor performs a rectal exam and looks at the anal tissue. An anoscopy, an exam of the anus and lower rectum, may also be done. If the tear is off to the side or does not heal, the doctor may look for other causes. That can include a colonoscopy, an exam of the colon, and a biopsy, which removes a small piece of tissue for testing.
Treatment
Most fissures heal on their own and do not need surgery. Treatment aims to break the cycle of pain, spasm, and low blood flow so the tear can heal. Steps include:
- Fiber and water. A high-fiber diet and fiber supplements (25 to 35 grams of fiber a day) make stools soft and easy to pass. Stool softeners can also help.
- Warm tub baths, called sitz baths. Sit in warm water 10 to 20 minutes a few times a day, especially after bowel movements. This soothes the area and relaxes the anal muscles.
- Prescription creams. Nitroglycerin ointment relaxes the sphincter and heals at least half of chronic fissures. Its main side effect is headaches, reported in at least 20% to 30% of patients, and it may lower your blood pressure. Calcium channel blocker creams, such as diltiazem and nifedipine, work in a similar way and heal 65% to 95% of chronic fissures.
- Procedures. Botox (botulinum toxin) injections into the sphincter heal 50% to 80% of chronic fissures. For fissures that do not heal, surgery called lateral internal sphincterotomy divides part of the internal sphincter muscle. It works in more than 90% of patients. Both are usually same-day procedures, and both can rarely affect control of gas or bowel movements.
Narcotic pain medicines are not recommended because they can cause constipation. Fissures often come back after a hard bowel movement, so keep up good bowel habits even after healing.
When to see a doctor
See a doctor right away if the tear is off to the side instead of in the middle, if you have several tears, or if it does not heal with home care. These can be signs of other problems, such as Crohn disease, an infection, or a tumor. Persistent anal pain should be checked to rule these out. Call 911 or go to the emergency room if you have bleeding that will not stop or you faint.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Your doctor can examine the area, suggest fiber and stool softeners, and check for other causes of bleeding. They can also follow healing and refer you to a specialist if it does not heal.
Common questions
Are anal fissures the same as hemorrhoids?
No. An anal fissure is a tear in the skin that lines the anal canal. Because some symptoms overlap, fissures are often confused with hemorrhoids.
How long does healing take?
Complete healing after medical or surgical treatment can take 6 to 10 weeks. Fissures often come back after a hard bowel movement, so keep up good bowel habits.
Can an anal fissure cause colon cancer?
No. Anal fissures do not increase the risk of colon cancer or cause it. However, more serious conditions can cause similar symptoms, so a doctor may still run tests.
When might I need surgery?
Most fissures do not need surgery. Chronic fissures are harder to treat, and surgery may be the best option when other treatments do not work.
Sources
- MedlinePlus - Anal fissure
- American Society of Colon and Rectal Surgeons - Anal Fissure Expanded Information
- American Society of Colon and Rectal Surgeons - Anal Fissure
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
