What is an anal fissure?

An anal fissure is a tear or crack in the skin lining of the anal canal. Fissures commonly occur due to straining when passing large, hard stools. Some fissures may also be associated with underlying conditions such as Crohn’s disease.

Symptoms of an anal fissure

A tear in the skin causes pain, and the underlying muscle may go into spasm, tightening the anus further and leading to more discomfort. Pain and irritation can last several hours after a bowel movement.

Symptoms include:

• Pain and discomfort when passing stools, which can persist for hours

• Persistent irritation and itching around the anus

• Bright red bleeding on toilet paper or in the toilet bowl

If you experience these symptoms, seeking medical advice is recommended.

How is an anal fissure diagnosed?

When you are seen in clinic, the consultant will:

• Take a full medical history and discuss your symptoms

• Perform a clinical examination, which may include:
  • Rigid sigmoidoscopy – a short camera examination of the rectum and anal canal
  • Proctoscopy – a closer examination of the anal canal

If the area is too painful to examine, an examination under anaesthetic (EUA) may be recommended.

If you are over 40 and have bleeding or changes in bowel habits, your consultant may suggest an endoscopic examination (flexible sigmoidoscopy or colonoscopy) to assess overall bowel health.

Treatment for an anal fissure

Most fissures heal without surgery. Treatment options include:

• Lifestyle and dietary changes
  • Increase fibre intake and fluids to keep stools soft
  • Use stool softeners to prevent straining
  • Take warm baths and maintain good personal hygiene
  • Over-the-counter haemorrhoid treatments may provide relief

• Prescription creams
  • GTN (Rectogesic) or Diltiazem (Anoheal) help relax anal muscles and improve blood flow
  • These need to be used for at least two months for effective healing
  • Potential side effect: headaches

• Botulinum toxin (Botox) injection
  • Used when specialist creams are ineffective
  • Relaxes the anal muscles, reducing spasm and allowing healing
  • Temporary side effect: mild leakage (rare, resolves within weeks)
  • Not specifically licensed for fissure treatment but widely used

• Surgical treatment
  • Lateral internal sphincterotomy – a small cut in the anal sphincter muscle to promote healing
  • Performed under general anaesthetic as a day procedure
  • Highly effective but may have a small risk of incontinence

Why choose the Midlands Bowel Clinic for your care?

• Specialist expertise in diagnosing and treating anal fissures
• Comprehensive care from initial assessment to recovery
• Access to advanced treatments for better outcomes

Contact us

If you have concerns about anal fissures, do not delay—book an appointment today at The Midlands Bowel Clinic for expert assessment and treatment.