Anal Fissure Treatment Guide | Symptoms, Healing, Diet & Surgery

An anal fissure is a small tear in the delicate lining of the anal canal. Even a small tear can cause severe pain because the area has dense nerve supply and strong sphincter muscles.

The pain creates a cycle: pain causes sphincter spasm, spasm reduces blood flow, reduced blood flow delays healing, and the wound reopens with the next hard stool.

Patients often describe a sharp glass-cutting or burning pain during bowel movement that can continue for minutes to hours. Bright red blood on tissue, fear of passing stool and anal tightness are common.

A chronic fissure may develop a skin tag called a sentinel pile. This can be confused with piles, so examination is important before choosing treatment.

Hard stool, constipation and straining are the most common causes. Diarrhoea, childbirth, low-fibre diet, dehydration and long-term anal spasm can also trigger or maintain fissures.

Treating only the wound is not enough. The stool pattern and sphincter spasm must also be addressed.

Acute fissures are usually treated with stool softeners, fibre, warm sitz baths, pain relief and muscle-relaxing ointments such as GTN or diltiazem when appropriate.

If a fissure is chronic or does not heal, Botox injection, laser fissurectomy or lateral internal sphincterotomy may be discussed. The choice depends on duration, sphincter tone and examination.

Soft stools are the foundation of fissure healing. Use high-fibre food, adequate fluids and prescribed stool softeners. Sitz baths reduce spasm and pain.

Avoid delaying toilet urges, prolonged straining, very spicy food and dehydration. Follow-up is important if pain continues beyond the expected healing window.