Anal Fissure
A small tear at the anus, usually from passing a hard poo. Sharp pain during and after, often bright red blood on the paper. Most heal in 6 to 8 weeks once stools stay soft.
The anal fissure ladder
Soft stools are the foundation of every step. Ointments buy the muscle time to relax; surgery is for the stubborn ones.
- Step 1 · Self-careFibre, water, stool softener and warm bathsKeeps stools soft so the tear can finally heal. Sit in warm water for 10–15 minutes after a bowel motion.
- Works
- Most new fissures heal with this alone (about 5–9 in 10). Ongoing fibre cuts repeat tears a lot
- Cost
- Psyllium or a stool softener about $10–20 a tub
- How long
- Daily; 6–8 weeks to heal, then keep the fibre going
- Watch for
- Bloating if you add fibre too fast. Build up over a week and drink plenty of water
Your bottom is begging for a softer delivery. Give it one.
- Step 2 · PharmacyNumbing ointment (lidocaine)Short-term pain relief before a bowel motion.
- Works
- Eases pain short term; in one trial healed fewer than fibre and baths (6 vs 9 in 10)
- Cost
- About $10–20
- How long
- Days to a few weeks
- Watch for
- Stinging or skin irritation. Not for long-term use
A painkiller, not a repair kit.
- Step 3 · PharmacyGlyceryl trinitrate (GTN) 0.2% ointmentRelaxes the tight anal muscle and boosts blood flow. Pharmacist-only.
- Works
- Heals about 5 in 10 long-standing fissures (vs about 3–4 in 10 on a dummy treatment)
- Cost
- About $35–45 for 30 g
- How long
- 2–3 times a day as directed, with a 12-hour break overnight; usually several weeks
- Watch for
- Headache (common, especially early on), light-headedness. Never use with erection medicines such as sildenafil or tadalafil: dangerous drop in blood pressure. Not for use in pregnancy or breastfeeding
A pea-sized dab, not a generous smear. Your head will thank you.
- Step 4 · PrescriptionDiltiazem ointmentSame muscle-relaxing idea, made up by a compounding pharmacy.
- Works
- Heals about as many as GTN (around half), with far fewer headaches
- Cost
- About $30–60 a tub on a private script
- How long
- 2–3 times a day for 6–8 weeks
- Watch for
- Itch or local irritation
GTN’s calmer cousin.
- Step 5 · SpecialistBotulinum toxin injectionTemporarily relaxes the muscle for 2–3 months, from a colorectal or general surgeon.
- Works
- Heals roughly 5–7 in 10; some come back
- Cost
- Free in public hospitals (waits apply); private costs vary, often several hundred dollars or more
- How long
- One quick procedure; effect lasts 2–3 months
- Watch for
- Temporary leaking of wind or stool in a few people
A temporary truce with your sphincter.
- Step 6 · ProcedureLateral internal sphincterotomyA small, precise cut in the anal muscle to stop it spasming.
- Works
- About 9 in 10 heal: the most effective option
- Cost
- Free in public hospitals (waits apply); private gap varies
- How long
- Day surgery; most heal within weeks
- Watch for
- Small risk of long-term leaking of wind or, less often, stool
The big fix, saved for when gentler options have had a fair go.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Steroid haemorrhoid creamsDid no better than fibre and warm baths in trials, and long-term steroid thins delicate skin.
- Manual anal stretchAn old operation that causes more leakage (incontinence) than modern surgery. Largely abandoned, and good riddance.
- Scented wipes and vigorous wipingFragrance and friction irritate a raw tear. Pat dry with plain water or soft paper.
What you can do
- Aim for 25 to 30 g of fibre a day: legumes, wholegrains, fruit and vegetables.
- Go when you feel the urge. Don’t strain, and don’t scroll your phone on the loo.
- Paracetamol helps. Avoid codeine, which causes constipation.
- Raise your knees on a footstool and pat dry gently.
See your GP if
- Pain is severe or not improving after 2 weeks
- Not healed after 8 weeks, or keeps coming back
- The tear isn’t at the front or back midline, or there are several (these need checking for other causes)
- You also have diarrhoea, weight loss or tummy pain, or you’re over 45 with bleeding or a change in bowel habit
See a doctor the same day for a hot, swollen, very painful lump near the anus, fever, or heavy bleeding.
Common questions
How long does an anal fissure take to heal?
Most heal within 6 to 8 weeks once stools are kept soft. See your GP if it hasn’t healed after 8 weeks or keeps coming back.
Does GTN ointment work for a fissure?
It helps: it heals about half of long-standing fissures, compared with about a third on a dummy treatment. It’s used a few times a day for several weeks, and headaches are common. Diltiazem ointment works about as well with fewer headaches.
Is it a fissure or haemorrhoids?
A fissure typically causes sharp pain during and for hours after a bowel motion, with bright red blood on the paper. Haemorrhoids more often cause painless bleeding, itch or a lump. Your GP can check which it is.
When is surgery needed for an anal fissure?
Only for fissures that don’t heal with fibre and ointments. A small cut in the anal muscle heals about 9 in 10, but carries a small risk of leaking wind or stool.
Can an anal fissure heal on its own?
Yes, most new (acute) fissures heal within 6 to 8 weeks with soft, regular poos, fibre, plenty of fluid and pain relief. Fissures lasting longer than about 8 weeks are called chronic and usually need a prescribed ointment or other treatment.
What does an anal fissure feel like?
A sharp, tearing pain while doing a poo, often described as like passing glass, followed by a burning or throbbing ache that can last minutes to hours. You may see a little bright red blood on the toilet paper.
Does Botox work for an anal fissure?
Botulinum toxin injected into the anal muscle relaxes it for about 3 months, giving the fissure time to heal. It heals roughly 6 to 8 in 10 chronic fissures, and a few people have short-term leakage of wind or poo.
Helpful resources
- National Continence Helpline (1800 33 00 66)Free, confidential advice from continence nurses on bowel problems, weekdays 8am–8pm. Australia only.
- Bristol stool chartFree download from the Continence Foundation of Australia. Handy for tracking what “normal” looks like and for showing your doctor.
- Queensland Health: Are you pooing properly?The footstool-and-lean-forward toilet position, explained. Free.
Evidence and more information
- Healthdirect: Anal fissure
- Cochrane: Non-surgical therapy for anal fissure
- AAFP: ASCRS anal fissure guidelines
maladywise.com/anal-fissure/