Prof. Dr. Emre Sivrikoz

Area of Expertise

Anal Fissure

An anal fissure is a small tear or crack in the delicate lining of the anal canal. The most common symptoms are sharp pain during bowel movements and bright red bleeding. With early treatment, it can often heal successfully, but when neglected, it may become chronic.

Information

What Is an Anal Fissure?

An anal fissure is a small tear or crack in the delicate lining of the anal canal. The most common symptoms are sharp pain during bowel movements and bright red blood on the toilet paper. In some cases it may heal on its own, but without proper treatment it can become chronic.

An anal fissure is a small tear in the inner lining of the anus that often causes severe pain during bowel movements. The most common triggers are hard stools and spasm of the anal sphincter muscle.

What Causes an Anal Fissure?

The most common cause of an anal fissure is passing hard stool and straining during bowel movements. Chronic constipation, frequent diarrhea, prolonged sitting on the toilet, childbirth-related strain, and excessive tightening of the anal muscle can also contribute to the development of a fissure.

Most common causes

  • Hard stool and straining
  • Chronic constipation
  • Frequent diarrhea episodes
  • Spending a long time on the toilet
  • Postpartum pelvic strain
  • Excessive anal sphincter spasm
These factors increase pressure in the anal canal and may lead to tearing of the delicate tissue.

Who Is More Likely to Develop an Anal Fissure?

Anal fissures are more commonly seen in the following groups:

People with constipation
Women after childbirth
People who sit for long periods
Individuals with stress-related muscle spasm
It can occur at any age, but bowel habits and muscle spasm play a major role.

What Are the Symptoms of an Anal Fissure?

Most common symptoms

  • Severe pain during bowel movements
  • Burning that may last for minutes or even hours afterward
  • Bright red blood on the toilet paper
  • A feeling of spasm or tightness around the anus
In some patients, pain continues long after a bowel movement and can significantly affect daily life.

Is an Anal Fissure Dangerous?

An anal fissure is usually a benign condition and does not turn into cancer. However, if it is left untreated, it may become chronic, cause persistent pain, and seriously reduce quality of life. Early evaluation is therefore important.

Difference Between Acute and Chronic Anal Fissures

Acute Fissure Recently developed. It often heals with proper medical treatment.
Chronic Fissure Persists for a longer period. The edges may become thickened and fibrotic.
Sentinel Tag In chronic fissures, a small skin tag may develop and surgery becomes more likely.

Can an Anal Fissure Heal on Its Own?

Acute anal fissures can sometimes heal on their own. However, in many patients the pain continues, healing is delayed, and the fissure becomes chronic if proper treatment is not started early.

How Is an Anal Fissure Diagnosed?

Diagnosis is usually made through careful clinical examination. Because pain may be severe, a detailed examination is sometimes postponed. In suspicious cases, additional investigations may be needed to rule out other underlying conditions.

1 Clinical evaluation

The duration of symptoms, type of pain, and bleeding pattern are reviewed.

2 Examination

The location of the fissure and associated sphincter spasm are assessed carefully.

3 Further assessment

If needed, extra evaluation is performed to exclude other diseases.

Treatment of Anal Fissure

Treatment is planned according to whether the fissure is acute or chronic. The initial goal is to reduce anal sphincter spasm, relieve pain, and allow the tear to heal.

High-fiber diet and constipation management The aim is to soften the stool and reduce trauma during bowel movements.
Warm sitz baths and topical creams These help relieve pain, reduce spasm, and support healing.
Botox injection In selected cases, it helps relax the sphincter muscle and promotes healing.

Surgical treatment

  • Surgery is considered in chronic fissures that do not respond to medical treatment.
  • Lateral internal sphincterotomy is one of the most effective and durable options in appropriate patients.

Is Surgery Necessary for an Anal Fissure?

Most patients improve without surgery. However, in chronic fissures, when there is no improvement after 6 to 8 weeks of proper treatment, or when pain significantly affects quality of life, surgery may offer the most effective and lasting solution.

Recovery After Surgery

  • Most patients can return to daily life within a short time.
  • Avoiding constipation is very important during recovery.
  • A high-fiber diet, adequate fluid intake, and regular bowel habits are recommended.
  • Following your doctor’s advice helps speed recovery and reduce the risk of recurrence.

Can an Anal Fissure Come Back?

Yes. Anal fissures may recur, especially in people who continue to have constipation, do not take enough fiber and fluids, or keep straining during bowel movements. Regular toilet habits and control of constipation are essential to reduce recurrence.

When should I see a doctor?

  • If you have severe pain during bowel movements
  • If rectal bleeding keeps recurring
  • If there is no improvement despite 6 to 8 weeks of treatment
  • If pain is clearly affecting your daily life

Early medical evaluation may reduce the need for surgery.

FAQ

Frequently Asked Questions About Anal Fissure

An anal fissure is a small tear or crack in the delicate skin inside the anus. It most commonly causes rectal bleeding and severe pain.
The most common cause is passing hard stool and straining. Constipation, diarrhea episodes, childbirth, sitting on the toilet for a long time, and excessive anal sphincter spasm may also lead to fissure formation.
Sharp, cutting pain during bowel movements, burning that can last for minutes or hours afterward, bright red blood on the toilet paper, and a feeling of anal spasm are the most common symptoms.
Usually not. An anal fissure is a benign condition. However, if it is left untreated for a long time, it may become chronic and seriously affect quality of life.
Acute fissures are newly developed and often heal with proper treatment. In chronic fissures, the tear becomes deeper, the edges become hardened, and a skin tag known as a sentinel tag may develop.
Diagnosis is usually made with a careful examination. Because of severe pain, a detailed examination may sometimes be postponed. In suspicious cases, further evaluation may be required to rule out other diseases.
Acute fissures may sometimes heal on their own. However, in many patients healing is delayed without proper treatment and the fissure may become chronic.
First-line treatment includes a high-fiber diet, stool softeners, warm sitz baths, and creams that help relax the anal sphincter. In cases where creams are not enough, Botox injection may relieve the spasm. Chronic or resistant cases may require surgery.
Most patients recover without surgery. However, in chronic fissures or in cases that do not respond to medical treatment, surgery is the most effective and durable solution.
Avoiding constipation, developing regular bowel habits, taking enough fiber and fluids, and avoiding straining can reduce the risk of recurrence. If the underlying constipation is not controlled, the fissure may come back.
Real Reviews

Patient Information Note

This content is for general informational purposes only and does not replace medical diagnosis or treatment. If you experience severe pain during bowel movements, rectal bleeding, or persistent anal symptoms, you should consult a general surgery specialist. Treatment of anal fissure is individualized.

Written by

Prof. Dr. Emre Sivrikoz, General Surgery Specialist
Clinical experience in colorectal surgery and proctology

Medical Review

Last updated: 02 / 2026

Sources

  • American Society of Colon and Rectal Surgeons (ASCRS)
  • UpToDate – Anal Fissure
  • National Institute for Health and Care Excellence (NICE)

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