Anal fissure symptoms: What are the early signs of anal fissure?

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician
Updated Jun 10, 2024  •  Published May 17, 2023
Fact Checked
In this article:

Overview: What does an anal fissure feel like?

An anal fissure is a small tear in the lining of the anal canal. These tears usually occur right down the middle of the back of the anus, but sometimes they happen down the middle of the front of the anus. Though small, an anal fissure is in a sensitive place and often causes severe and sharp pain during and after defecation. The pain can last for an hour or more afterward. The pain is often so severe that some people go to the emergency room for help. The fissure may bleed when defecating, but usually not much. It will appear as bright red blood on toilet paper or in the toilet bowl. Like most tears and cuts in the skin, anal fissures typically heal on their own, but sometimes they don’t. Chronic fissures—that don’t go away or keep coming back—may require serious medical treatment like drugs or surgery. In some cases, the fissure may be caused by a serious medical condition, so it is important to see a healthcare provider and follow-up as needed.

Key takeaways:

  • An anal fissure is a common condition and affects anyone regardless of age, sex, race, or ethnicity. 

  • Symptoms of anal fissures include pain during defecation and sometimes minor bleeding.

  • Serious symptoms of an anal fissure, such as bleeding that won’t stop, may require immediate medical attention, but this is rare.

  • An anal fissure is usually caused by injury to the anal sphincter due to constipation, hard stools, diarrhea, childbirth, prior anal surgery, or anal sexual penetration. Other less common causes of anal fissures include tuberculosis, HIV/AIDS, anal cancer, inflammatory bowel disease (IBD), and sexually transmitted infections (STIs). 

  • Anal fissures can be self-diagnosed but may require a medical diagnosis if they do not heal.

  • An anal fissure generally requires self-care to get better but may require medical treatment if it doesn’t get better or other symptoms are present. Anal fissure symptoms typically resolve with treatment within a few days to three weeks.

  • Treatment of anal fissures may include increased fluid intake, a high-fiber diet, fiber supplements, over-the-counter stool softeners, warm baths (to help decrease the anal spasm after a bowel movement), and prescription topical medicines. Rarely Botox (botulinum toxin) injections or surgery are needed. Read more about anal fissure treatments here.

  • Untreated anal fissures could result in complications like bleeding, pain, infections, fecal incontinence, anal fissure recurrence, or anal fistula.

Use coupons for anal fissure treatments like Colace (docusate), Metamucil Fiber (psyllium), and Citrucel (methylcellulose) to save.

What are the early signs of an anal fissure?

Most people will be aware of an anal fissure when it first tears, usually during defecation. The pain is often very sharp and may involve a small amount of blood. These are the most common early signs of an acute anal fissure.

Other anal fissure symptoms

An anal fissure is a small tear in a very sensitive place, the lining of the anus, so the most common symptoms of an anal fissure include:

  • Pain, especially during bowel movements

  • Irritation and discomfort

  • Itching

  • Minor bleeding

  • A bump or skin tag at the opening of the anus

Anal fissure vs. hemorrhoids symptoms

The most common cause of anal pain is hemorrhoids, which are easily confused with anal fissures because they both cause pain. The symptoms are very similar. A physical examination by a healthcare provider can easily tell the difference. However, there are a few clues. First, an anal fissure hurts the most when pooping and lessens after a bowel movement. Hemorrhoids may hurt during bowel movements, but the pain is often throughout the day. 

Anal fissure Hemorrhoids
Shared symptoms
  • Pain
  • Irritation
  • Itching
  • Minor bleeding
Unique symptoms
  • Pain is worse during bowel movements and gradually improves after bowel movements
  • Bowel movements do not necessarily worsen pain
  • A bump at the opening of the anus or just inside
  • Swelling

RELATED: Hemorrhoid treatments and medications

Types of anal fissures: How can I tell which one I have? 

Healthcare professionals diagnose anal fissures as acute or chronic. 

An acute anal fissure is a short-term problem in which symptoms are experienced for six weeks or less. 

Chronic anal fissures are a long-term complaint. Symptoms have gone on for over six weeks, or the anal fissure keeps returning. Not only do people with chronic fissure have persistent symptoms, but the fissure is often worse. While acute fissure is typically a superficial tear, chronic fissure can extend deeper and expose the sphincter muscle.

Treatments will vary. An acute anal fissure is usually treated conservatively with dietary changes, sitz baths after defecation, and stool softeners. Chronic anal fissure requires prescription topical drugs or surgery to get better.

When to see a doctor for anal fissure symptoms

Most anal fissures heal in a few days. Self-care is sufficient as treatment. See a doctor or other healthcare professional if the fissure does not heal for several weeks. 

If the anal fissure is accompanied by other symptoms such as abdominal pain, weight loss, incontinence, or thin stools, see a doctor. The fissure may be due to a more serious condition causing the fissure. Bleeding due to fissures is usually minor, but if there’s copious rectal bleeding or bleeding that doesn’t stop, go to an emergency room. Brisk rectal bleeding is probably caused by a more serious medical condition.

Healthcare professionals typically diagnose an anal fissure from medical history and rectal examination. Examining the anus will help the clinician rule out other problems and determine a possible cause for the fissure. The clinician will focus on the appearance of the fissure—where it’s located, the appearance of the surrounding tissues, and if there are any other problems in the anal area.

If the fissure is in an atypical location, the clinician will conduct a more thorough history and physical examination to uncover the cause. Blood tests, urinalysis, and possibly medical imaging or an endoscopic examination of the anus (anoscopy), rectum (sigmoidoscopy), or large intestine (colonoscopy) may be required. Possible causes of atypical fissures include Crohn’s disease, ulcerative colitis, HIV/AIDS, tuberculosis, and anal cancer.

Complications of anal fissure

The most common complications of anal fissures are:

  • Ongoing discomfort and pain

  • Decreased quality of life

  • Bleeding

  • Infections

  • Incontinence (due to surgery)

  • Fistula formation

How to treat anal fissure symptoms

Anal fissure treatment is usually conservative, consisting of self-care. This is true even when a doctor diagnoses the fissure. Initial treatments of an acute anal fissure include:

  • Stool softeners (to make stools easier to pass without causing pain or worsening the fissure)

  • Increased fluid intake (to loosen and soften stools, making them easier to pass)

  • Sitting in warm water after a bowel movement to decrease anal sphincter spasm

  • A high-fiber diet or fiber supplements to make stools easier to pass

Chronic fissures often don’t heal without medical treatment. If an anal fissure does not heal or symptoms of an anal fissure last for several weeks, then healthcare providers prescribe topical prescription medications or perform surgery to heal the fissure: 

Botox injections and surgery are usually reserved for anal fissures that don’t resolve with topical drugs because of complications like chronic fecal incontinence. They both have a high rate of success in resolving anal fissures. Anal fissures are completely cured in 96% of people who get a sphincterotomy and 50% to 80% of people who have botulinum toxin injections. 

Living with anal fissures

A few home treatments are the standard way to treat most anal fissures:

  • Take regular sitz baths in warm water after a bowel movement.

  • Eat more fiber or take fiber supplements.

  • Drink more water and other fluids to loosen up your stools.

  • Use a stool softener laxative to make bowel movements easier.

  • Avoid stimulant laxatives like Ex-Lax (senna) or Dulcolax (bisacodyl). They may make the problem worse by pushing out hard stools with more force.

  • Keep bowel movements on a regular schedule.

  • Stay away from spicy foods—they can worsen the pain when passing stools.

  • Take all the medications prescribed as instructed.

A sphincterotomy may require some special care for several weeks:

  • Follow the post-op instructions given to you by the surgeon

  • Take all medications as instructed

  • Avoid strenuous exercise

  • Take warm baths

  • Take fiber supplements

  • Don’t worry about incontinence—more than 90% of people with a sphincterotomy eventually recover full control over their bowel movements in a few years

Most importantly, if you have an anal fissure, take care of it

If you have an anal fissure, it’s often hard to ignore. The good news is that it will go away in most cases. The better news is that it will improve more quickly and surely if you take care of it by eating more fiber, drinking more fluids, taking stool softeners, and indulging in a few warm baths. 

FAQs about anal fissure symptoms

Do anal fissures hurt all day?

Bowel movements usually provoke anal fissure pain. The pain can be intense or excruciating when passing stools and linger well after the bowel movement is finished. The anus may feel uncomfortable, sore, or itchy for the rest of the day.

Do anal fissures hurt when you wipe?

An anal fissure is a cut in the anal canal, so wiping the anus sometimes won’t bother it. However, the bottom of the cut can extend to the bottom of the anus, so wiping that area might cause irritation or pain.

When should I be worried about anal fissures?

Like any skin cut, an acute anal fissure usually heals in a few days. See a doctor or other healthcare provider if it does not heal after a few weeks. It may be due to a more serious medical condition. Even if it is not due to a more serious condition, a chronic anal fissure usually requires treatment to get better.

What’s next? Additional resources for people with anal fissure symptoms

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician

Leslie Greenberg, MD, is a board-certified practicing family physician with more than 25 years of doctoring experience. She was a psychology major at Northwestern University near Chicago, then graduated with an MD from the University of Nevada School of Medicine. She completed her family medicine residency at St. Joseph Hospital in Wichita, Kansas. She has trained more than 350 family medicine resident-physicians, been in private practice, and delivered babies for 22 years.

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