Anal Fissure: Why It Hurts So Much, Treatments That Help and How to Let It Heal

An anal fissure is a small tear in the skin of the anus, and it can be surprisingly painful. Many people suffer in silence because they’re embarrassed. Most fissures heal within a few weeks with softer stools and simple care, and there are effective treatments if they don’t.

Imagine dreading every trip to the toilet. Each time, there’s a sharp, tearing pain like passing broken glass, a streak of bright red blood on the paper, and then a deep burning ache that lasts an hour. You start putting off going, which makes your stools harder and the next time worse. That cycle is exactly what keeps a fissure from healing.

Symptoms

• Sharp pain during a bowel movement, often followed by burning or aching that can last hours
• Bright red blood on toilet paper or on the surface of the poo
• Sometimes a small lump or skin tag near the tear

Piles (haemorrhoids) can also bleed, but are more often itchy or uncomfortable rather than sharply painful.

Common causes

• Constipation and passing hard or large stools
• Ongoing diarrhoea
• Pregnancy and childbirth
• Less commonly, Crohn’s disease, infections or other conditions

How to help it heal

• Keep stools soft: eat more fibre (fruit, vegetables, whole grains, pulses), drink plenty of water, and ask a pharmacist about a bulk-forming laxative or stool softener
• Don’t delay going when you feel the urge, and don’t strain
• Warm baths (sitz baths) can relax the muscle and ease pain
• Pain relief: paracetamol, or a numbing cream from a pharmacist. Avoid codeine-based painkillers, which cause constipation.
• Prescription ointments such as glyceryl trinitrate or diltiazem relax the anal muscle and improve blood flow, helping chronic fissures heal. They’re usually used for six to eight weeks.

Fissures that don’t heal after several months may be treated with Botox injections or a small operation.

But when is bleeding from the bottom a worry?

See a doctor or nurse if bleeding continues, if blood is dark or mixed in with the poo, if you’re over 50, or if you also have a change in bowel habit, weight loss, tiredness or a lump. These need checking to rule out other conditions, including bowel cancer. Get urgent help for heavy bleeding or feeling faint.

Sources: NHS (Anal fissure), NICE Clinical Knowledge Summary on anal fissure, American Society of Colon and Rectal Surgeons, US National Institute of Diabetes and Digestive and Kidney Diseases. This guide is for general information and does not replace advice from your own nurse, doctor or pharmacist.