Anal Fissure Treatment and Surgery

What Is an Anal Fissure?

An anal fissure is a tear in the lining of the anal canal, the short passage through which stool exits the body. Common causes of fissures are trauma from passing hard stools, constipation, diarrhoea, or repeated irritation.

Fissures may be acute or chronic.

Acute fissures are recent tears or cracks in the lining of the anal canal. Many heal with conservative treatment, such as stool softeners, increased dietary fibre, and avoiding straining during bowel movements.

Chronic fissures last more than six weeks and may develop features such as exposed internal muscle fibres, scar tissue, or skin tags. They may also be associated with small skin tags near the fissure or recurrent symptoms.

Chronic fissures are harder to heal, partly due to the pain-spasm cycle. Pain from the fissure causes the muscle around the anal opening to tighten. This reduces blood flow to the area, which then delays healing of the fissure.

Fissures are often mistaken for haemorrhoids because both may cause pain and bleeding. A clinical evaluation can help distinguish between the two.

Symptoms of an Anal Fissure

Anal fissure symptoms include pain during or after bowel movements, and bright red blood on the stool or toilet paper. Other symptoms include these:

Sharp, tearing, or “cuttingˮ pain during bowel movements
Burning, itching, or irritation around the anus
Spasm or tightness of the anal sphincter
A visible crack in the skin around the anal area
Reluctance to pass stool due to pain, which can worsen constipation
A small skin tag near the fissure in (more commonly seen in chronic cases)

When Should You See a Doctor?

Many fissures can improve with simple measures, but others may need medical attention. See a specialist if you experience any of the following:

Pain or bleeding that does not improve after 1-2 weeks of self-care
Recurrent fissures that keep coming back
Severe pain that makes bowel movements difficult
Bleeding that is heavy, persistent, or not clearly linked to a bowel movement
Fissures that are painless, multiple, or located away from the typical midline position
Fissures associated with discharge, fever, weight loss, diarrhoea, or symptoms inflammatory bowel disease

Not all anal bleeding is due to fissures. Haemorrhoids, infections, inflammatory bowel disease, polyps, and colorectal cancer can also cause similar symptoms. A professional medical evaluation is important to determine the underlying cause and rule out other possible conditions.

Consult a Specialist for Anal Fissure Treatment Options

If you have pain, bleeding, or any of the symptoms listed above, speak with our specialist for an assessment and treatment plan.

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How Are Anal Fissures Diagnosed?

Diagnosis of anal fissures is usually based on symptoms and a gentle physical examination. Our specialist will begin by reviewing your symptoms and medical history, followed by a gentle examination of the anal where appropriate.

Our specialist may assess whether the fissure appears acute or chronic, and note its location. Fissures located away from the typical midline position (such as the side of the anal opening) may be associated with underlying conditions such as Crohnʼs disease.

If the pain is severe, a digital rectal examination or anoscopy may be delayed until the pain settles, as these examinations can be uncomfortable during an acute fissure. Further investigations may be recommended if symptoms are atypical or if another underlying condition is suspected.

For older patients or those with unexplained rectal bleeding, a colonoscopy may be considered to rule out other possible causes.

Non-Surgical Treatment for Anal Fissures

Non-surgical treatment is the first-line approach for most fissures, especially acute ones.

The goals are to soften stool, reduce pain, relax the anal sphincter, reduce pressure around the fissure, and promote healing of the tear.

Stool Softening and Constipation Control

One of the most important steps is to address factors that may contribute to the fissure, such as constipation or straining.

Increase fibre gradually through diet or supplements
Drink enough water to stay well hydrated
Use stool softeners or osmotic laxatives if needed
Avoid straining and prolonged sitting on the toilet
Manage diarrhoea if loose stools are contributing to irritation

Warm Sitz Baths

Warm sitz baths for 10 to 20 minutes, taken a few times a day, especially after bowel movements, can help soothe the area and relax anal sphincter muscles. If topical medication has been prescribed, you may be advised to apply it after the sitz bath.

Pain Relief

Oral painkillers may be used when appropriate. Topical anaesthetic creams may provide short-term pain relief but should not replace treatments that promotes healing.

Topical Medications

Topical medications works by relaxing the internal anal sphincter, which may help ease the pain-spasm cycle and improves blood flow to the area.

Glyceryl trinitrate (GTN) ointment may be prescribed to help relax the internal anal sphincter, reducing anal pressure and supporting healing. However, headache is a commonly reported side effect.

Calcium channel blocker creams, such as diltiazem or nifedipine, may be used as alternatives. These medications may be associated with fewer headaches than GTN in some patients.

Whatever medication is prescribed, it is important to use it as directed, which may involve consistent application for several weeks, even if symptoms improve earlier.

When Is Surgery Needed for an Anal Fissure?

Surgery is usually considered for chronic fissures that do not heal despite appropriate medical treatment. It may also be considered for recurrent fissures that repeatedly return despite stool management and topical therapy.

The decision depends on factors such as symptoms, fissure duration, sphincter tone, continence risk, previous childbirth or anorectal surgery history, and patient preference.

If surgery is recommended, the aim is to break the pain-spasm cycle and improve blood flow to the area to support healing of the fissure.

What to Expect

Before the Procedure

You will first have a consultation with a colorectal specialist to confirm the diagnosis and assess whether surgery is appropriate for you. Our specialist will review your medical history, childbirth history, continence symptoms, medications, and any previous anorectal procedures.

We will explain the available treatment options, including the benefits, risks, and expected recovery for each approach. You will have the opportunity to ask questions, and we will do our best to address them clearly.

Our team will also provide all pre-operative instructions in advance.

During the Procedure

Anal fissure surgery is usually performed as a day surgery under general anaesthesia or regional anaesthesia. Most patients are able to go home on the same day.

The fissure surgery procedure used will depend on your circumstances.

Lateral Internal Sphincterotomy: This is the most commonly performed fissure surgery procedure for chronic anal fissures. The surgeon makes a small cut in part of the internal sphincter muscle to reduce resting pressure and support healing of the fissure.
Fissurectomy: This involves removing the chronic fissure tissue and associated scar tissue or skin tag. It may be performed on its own or in combination with other techniques, and may be considered when sphincterotomy carries a higher risk of incontinence.

After the Procedure

Most patients go home the same day. Mild discomfort, bleeding, and discharge is relatively common in the early days after surgery. Pain often improves as the sphincter spasm settles.

It is important to continue stool softeners, maintain good hydration, eat adequate fibre, and take warm sitz baths if directed during recovery.

Our team will arrange follow-up appointments to monitor your healing and address any ongoing symptoms.

Recovery After Anal Fissure Treatment or Surgery

Recovery depends on the treatment received.

Patients on topical medication may see some improvement within the first few days to weeks, although the full course should still be completed. For those who have undergone surgery, many patients are able to return to light daily activities within a few days, depending on their symptoms and the type of procedure performed.

Complete healing may take several weeks, depending on the severity of the fissure and the treatment approach.

To support recovery, our specialist may advise the following:

Keep stools soft
Avoid straining
Clean the area gently after bowel movements
Use warm baths if advised
Take pain relief as prescribed
Attend follow-up appointments

Who Is Suitable for Anal Fissure Surgery?

Anal fissure surgery is not appropriate for everyone. Suitability must be assessed on an individual basis.

Surgery may be considered for:

Patients with chronic fissures that have not healed after appropriate medical treatment
Patients with recurrent fissures causing repeated pain and bleeding
Patients with high resting sphincter tone and classic posterior midline fissures (for lateral internal sphincterotomy)
Patients with continence risk factors, where alternatives to sphincterotomy, such as botulinum toxin, fissurectomy, or advancement flap procedures, may be considered

The most appropriate treatment approach depends on a careful review of each patientʼs history, assessment findings, and individual circumstances.

Procedures and Surgeries

Anal Fistula Removal

Groin Hernia Mesh Repair

Haemorrhoid Laser Treatment

Gallbladder Removal

Hernia Repair Keyhole Surgery

Piles Surgery

Tailbone Abscess Removal

Laparoscopic Colectomy

Colon Polypectomy

Perianal Abscess Drainage

Anal Fissure Treatment & Surgery

Consult a Specialist for Suitable Treatment Options

Experiencing the symptoms of an anal fissure? Speak with our specialist to find the right anal fissure cure for your condition, whether non-surgical or surgical.

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