Anal Fissure
A small tear in the lining of the anus, usually from passing a hard stool. It causes sharp pain during and for hours after a bowel motion, often with bright red blood on the paper. Most heal within 6 to 8 weeks.
Treatment options
Ratings show how strong the research is.
- Strong evidenceSurgery (sphincterotomy)A small cut in the anal muscle for fissures that don’t heal. Heals about 9 in 10, but carries a small risk of leaking wind or stool.
- Moderate evidenceFibre, water and stool softenerKeeps stools soft so the tear can heal. The first step for everyone.
- Moderate evidenceGlyceryl trinitrate (GTN) ointmentRelaxes the muscle and improves blood flow. 0.2% ointment twice daily for 6 to 8 weeks, from a pharmacist. Headaches are common.
- Moderate evidenceDiltiazem or nifedipine ointmentWorks about as well as GTN with fewer headaches. Made by a compounding pharmacy on prescription.
- Limited evidenceBotulinum toxin injectionRelaxes the muscle for 2 to 3 months. An option from a surgeon if ointments fail.
- Limited evidenceWarm bathsSit in warm water for 10 to 15 minutes, 2 to 3 times a day, especially after a bowel motion.
- Limited evidenceNumbing creamEases pain short-term but doesn’t help healing.
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 or put it off.
- 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
- You also have diarrhoea, weight loss or tummy pain
See a doctor the same day for a hot, swollen, very painful lump near the anus, fever, or heavy bleeding.
Evidence and more information
- Healthdirect: Anal fissure
- Cochrane: Non-surgical therapy for anal fissure
- AAFP: ASCRS anal fissure guidelines
maladywise.com/anal-fissure/