An anal fissure, also called an anal ulcer or rectal fissure, is a small tear or crack in the thin, sensitive lining of the anus. It commonly develops when the anal tissue is stretched or injured, often while passing a large or hard stool. Anal fissures can cause sharp, severe pain during bowel movements, and the pain may continue for minutes or even several hours afterward. Small amounts of bright-red blood may also appear on the surface of the stool or on toilet paper. Most anal fissures are not serious and heal with simple measures such as keeping stools soft, drinking enough fluids, eating adequate dietary fiber, and avoiding straining during bowel movements. However, fissures that persist, repeatedly return, or occur without an obvious cause may require medical evaluation and treatment. An anal fissure may be acute, meaning it has recently developed and usually heals within several weeks, or chronic, meaning it persists for a longer period or keeps recurring. Chronic fissures may be associated with a small skin tag or a visible lump near the tear.
Common signs and symptoms of an anal fissure include:
Sharp or severe pain during bowel movements, often described as cutting, tearing, or burning pain
Pain or discomfort that may continue for several hours after passing stool
Bright-red blood on the surface of the stool, toilet paper, or in the toilet bowl
Anal itching or irritation
A burning sensation around the anus
A visible crack or tear in the skin around the anal opening
A small skin tag or lump near the fissure, particularly with a chronic fissure
Spasm or tightness of the muscles around the anus
Fear of having a bowel movement because of anticipated pain
Constipation or avoidance of bowel movements because of pain
The amount of bleeding from an anal fissure is usually small. Heavy bleeding, black or tarry stools, unexplained weight loss, or persistent changes in bowel habits should be medically evaluated because they may indicate another condition.
Conditions such as Crohn’s disease can cause inflammation around the anus and may lead to fissures that are multiple, recurrent, or located in unusual positions.
Although uncommon, anal cancer can sometimes cause symptoms resembling those of an anal fissure. A fissure that does not heal or has unusual features should therefore be assessed by a healthcare professional.
Certain infections can cause inflammation and ulceration around the anus and may result in fissure-like lesions. These can include HIV infection, tuberculosis, syphilis, and herpes.
Repeated trauma or irritation to the anal area and conditions that affect normal bowel movements may also contribute to the development of an anal fissure.
Conditions or infections that cause inflammation around the anus
People who have already experienced an anal fissure may be more likely to develop another one, especially if constipation or other underlying bowel problems continue.
A fissure that persists or repeatedly returns may become chronic. Chronic fissures can be associated with a skin tag near the fissure and changes in the underlying anal muscle. They may require prescription medicines or a procedure if conservative treatment does not work.
A healthcare professional can often diagnose an anal fissure from the person’s symptoms and a careful examination of the anal area. The doctor may ask about:
Pain during and after bowel movements
The duration and severity of symptoms
Constipation or diarrhea
Bleeding
Previous anal fissures
Changes in bowel habits
Medical conditions such as Crohn’s disease or other inflammatory bowel disease
A gentle visual examination may be enough to identify the fissure. A more extensive examination may not be necessary when the fissure is clearly visible and typical. If the fissure is unusual, recurrent, difficult to diagnose, or associated with other concerning symptoms, additional tests may be recommended to look for an underlying disease.
Eating fiber-rich foods and drinking adequate fluids can help make stools softer and easier to pass. Fiber may be obtained from vegetables, fruits, whole grains, legumes, and other high-fiber foods. A healthcare professional may recommend a fiber supplement or stool-softening medicine when appropriate.
Avoid pushing or straining excessively during bowel movements. Responding to the urge to pass stool rather than repeatedly delaying it may also help prevent constipation.
For fissures that do not heal with basic measures, a doctor may prescribe medicines that help relax the anal sphincter and improve blood flow to the affected tissue. These treatments can promote healing and reduce pain.
If an anal fissure is associated with Crohn’s disease, an infection, or another medical condition, treating the underlying problem is an important part of management.
Chronic fissures that do not respond to medical treatment may require a procedure. Options can include injection of botulinum toxin into the anal sphincter or a surgical procedure such as lateral internal sphincterotomy. Surgery is generally considered when other treatments have not adequately healed a persistent fissure. The appropriate treatment should be decided by a qualified healthcare professional.
There is a lump, swelling, or unusual growth around the anus
You have persistent diarrhea or constipation
You have unexplained weight loss or significant changes in bowel habits
You have symptoms of inflammatory bowel disease
The fissure appears in an unusual location or there are multiple fissures
You have symptoms that could indicate an infection
Seek prompt medical attention for heavy rectal bleeding, severe worsening pain, fever, or significant swelling, as these symptoms may indicate another condition requiring urgent evaluation.
Most anal fissures are not serious and heal with appropriate treatment. However, persistent or recurrent fissures should be evaluated to identify an underlying cause and determine appropriate treatment.
Many acute anal fissures improve and heal within several weeks when the stool is kept soft and straining is avoided. Chronic fissures may take longer and may require prescription treatment or a procedure.
Both can cause anal bleeding and discomfort, but they are different conditions. An anal fissure is a tear in the anal lining, whereas hemorrhoids are swollen veins in or around the anus and lower rectum. A medical examination can help determine the cause of symptoms.
Many acute fissures can heal without surgery when bowel movements are kept soft and the anal area is allowed to heal. Persistent fissures should be evaluated by a healthcare professional.
No. Rectal bleeding can have many causes, including hemorrhoids, inflammatory bowel disease, infections, polyps, and cancers. Recurrent or unexplained bleeding should be evaluated rather than automatically attributed to an anal fissure.
Medical Disclaimer: This article is intended for general educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. If you have persistent anal pain, rectal bleeding, a non-healing fissure, or other concerning symptoms, consult a qualified healthcare professional.
