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Anal Fissure
Key takeaways
When anal fissures do not heal on their own, prescription medication such as topical nitroglycerin, topical calcium channel blockers, or injectable Botox may be recommended.
Over-the-counter medicine for anal fissures may include bulk-forming laxatives like psyllium and topical anesthetics like lidocaine.
At home, you can try things like drinking plenty of water, eating more fiber, and taking warm baths.
An anal fissure is a tear in the lining of the anus, usually caused by passing hard stools or straining too hard when passing stools. An anal fissure can be acute (short-term) or chronic (ongoing). If the fissure persists for more than six weeks, the problem is chronic. Chronic anal fissures are usually deep, sometimes deep enough to reveal the anal sphincter muscle. If you have symptoms of an anal fissure, such as red blood in your poop, or pain, burning, or itching with bowel movements, see a healthcare provider for a diagnosis and treatment plan.
How is an anal fissure diagnosed?
The diagnosis of an anal fissure is primarily clinical and consists of a history and a visual examination of the anus. If the fissure is not immediately visible, the healthcare provider may inspect the anus using a small scope called an anoscope.
In many cases, the visual identification of an anal fissure is all that’s required for a diagnosis.
However, if a more serious problem is suspected, a healthcare provider may order further testing, such as a flexible sigmoidoscopy or a colonoscopy, to rule out other possibilities such as cancer or Crohn’s disease.
Anal fissure treatment options
For acute anal fissures, the best treatment is time and a few lifestyle changes to aid the healing process. Many anal fissures will heal in a few weeks, but fissures that go on for longer than six weeks may require medications or surgery to relax the anal sphincter.
Prescription medications
Chronic anal fissures may require medications to relax the anal sphincter muscles, such as topical nitroglycerin or topical calcium channel blockers. For severe cases, an injection of botulinum toxin A can relax the anal sphincter for several months to allow for healing.
Surgery
A colorectal surgeon may recommend surgery when a chronic anal fissure does not heal with medications or if the pain is too severe. The surgeon will perform a lateral internal sphincterotomy (LIS), an outpatient procedure done under local anesthesia, which involves cutting a portion of the anal sphincter. The cut will loosen the internal anal sphincter muscle and eliminate the spasms that worsen the condition.
Home treatment
An anal fissure, like a cut on the skin, will usually heal in a few weeks. Once the fissure has healed, home treatment will involve preventing a recurrence. Continue to drink a lot of water and eat a diet high in fiber to prevent constipation and hard bowel movements that can cause another anal fissure.
Types of anal fissure medication
Many anal fissures will require only non-prescription laxatives or pain relief creams to heal. Fissures that don’t heal may require medications that relax the anal sphincter to prevent the muscle spasms that worsen the condition. These medications are usually sufficient to allow the tissues to heal on their own.
Topical nitroglycerin
For chronic anal fissure, topical nitroglycerin may be used. Normally used to relax blood vessels, nitroglycerin ointment is an effective medicine for relaxing the anal sphincter to treat an anal fissure. A nitroglycerin ointment may need to be compounded by a compounding pharmacy.
Topical calcium channel blockers
Topical calcium channel blockers such as nifedipine or diltiazem are sometimes used for chronic anal fissures. These products will require compounding by a compounding pharmacy or facility.
Botulinum toxin injection
When conservative drug therapy does not work, botulinum toxin A, better known as Botox, can be effective at relaxing the anal sphincter. Injected beneath the tissues near the anal sphincter, the botulinum toxin relaxes the anal sphincter and reduces spasms of the inner anal sphincter muscle for about two to three months after the injection, allowing for healing.
Over-the-counter anal fissure medicine
Healthcare providers often recommend over-the-counter medicines for anal fissures. Bulk-forming laxatives, like Metamucil (psyllium), may help soften your stool if you are straining with bowel movements. Topical anesthetics, like lidocaine, can be applied to the area to temporarily numb pain. Your healthcare provider can recommend OTC products that may help with your symptoms.
The best medication for an anal fissure will depend on the severity of the condition and the patient’s tolerance for side effects. For an acute anal fissure, a laxative and an over-the-counter topical anesthetic may be enough to help speed up the healing process. For chronic anal fissure, the goal of medication is to relax the anal sphincter so that the tear can heal.
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Best medicine for anal fissures
| Drug name | See SingleCare price |
|---|---|
| Metamucil | Get free coupon |
| Psyllium Fiber | Get free coupon |
| Aspercreme W/Lidocaine | Get free coupon |
| Nifedipine | Get free coupon |
| Diltiazem | Get free coupon |
| Nitro-Bid | Get free coupon |
| Botox | Get free coupon |
This is not an exhaustive list of anal fissure medications. Always ask your healthcare provider for the best treatment for anal fissures based on your health condition and medical history.
Common side effects of anal fissure medicine
Different classes of medications have different side effects. For example, laxatives may cause gas, bloating, and diarrhea. Topical medications may cause temporary burning or irritation. Consult with a healthcare professional for possible side effects and drug interactions based on your specific situation.
Home remedies for an anal fissure
Like a cut on the skin, the anal fissure needs time to heal. The goal of in-home treatment is to prevent constipation and hard bowel movements that will put more strain on the fissure. Relaxing the anal sphincter will also help the fissure to heal.
Drink more water. Drinking plenty of water will make stools softer and easier to pass.
Eat more fiber. Fiber promotes regular bowel movements.
Use bulk-forming laxatives. Bulk-forming laxatives can help people with constipation or hard stools. They absorb water into the stool, making it bigger, softer, and easier to pass.
Take warm baths. A 10- to 15-minute warm bath or sitz bath taken three times a day will relax the anal sphincter and increase blood flow to the anus, helping to speed healing.
Expert takeaway
"Getting enough fiber can be hard if you are not used to it," says Karen Berger, Pharm.D., member of the SingleCare Medical Review Board. "Experts often recommend increasing your fiber intake slowly, so your body can adjust. Also, a registered dietitian can help you find ways to incorporate fiber into your diet in a way that works with your lifestyle."
Frequently asked questions about anal fissures
Are anal fissures dangerous?
Anal fissures are not considered dangerous, but if they do not heal, they can cause severe pain and scarring. Anal fissures may be caused by another medical condition. If you have rectal pain or bleeding, consult a healthcare provider.
What is the best cream for fissures?
Over-the-counter anesthetic creams, such as lidocaine, can help people manage the pain. For chronic fissures, a physician may order prescription creams to relax the anal sphincter to give the fissure time to heal.
What causes an anal fissure?
An anal fissure is usually caused by trying to pass hard or large stools and is due to both the hardness of the stool and the tightness of the anal sphincter. Chronic diarrhea, inflammatory bowel disease, childbirth, and medical procedures can also cause an anal fissure.
Why is my fissure not healing?
Most anal fissures will heal in a few weeks if measures are taken, such as drinking more water and eating more fiber. The fissure might not heal if constipation or hard bowel movements continue. Chronic anal fissures are often caught in a cycle of repeated damage. The pain might irritate the inner anal sphincter muscle and cause it to spasm. The spasm then pulls the fissure apart even more or blocks blood flow to the area, slowing the healing process. The goal of chronic anal fissure treatment is to relax the anal sphincter to stop the spasms.
How long do anal fissures last?
Most anal fissures will heal in a few weeks. If your anal fissure has not healed after six weeks, consult your healthcare provider.
How do you permanently heal a fissure?
Like a cut on the finger, fissures do heal permanently. For many people, the only therapy required is time, lots of liquids, a diet high in fiber, and taking a few warm baths every day. Chronic anal fissures are due to spasms of the anal sphincter that keep opening the fissure and even making it bigger. The goal of drug therapy or surgery is to relax the anal sphincter so that the fissure can heal on its own.
How can I treat a fissure at home?
The goal of home treatment is to give the injury the space to heal by softening stools and relaxing the anal sphincter. Drinking lots of water and eating a high-fiber diet is usually enough to soften stools, but a bulk-forming laxative may be required. Warm baths or sitz baths three times a day will both relax the anal sphincter and increase blood flow to the injured area. Pain can be managed with a topical anesthetic such as lidocaine.
How do I know if I have a hemorrhoid or fissure?
An anal fissure is a tear in the anal lining, and a hemorrhoid is a swollen vein (like a varicose vein) that balloons out with blood. Hemorrhoids typically cause itching or discomfort, while anal fissures cause sharp pain during bowel movements. The only sure way to know the difference is to have a healthcare professional examine the area.
Is Vaseline good for fissures?
Vaseline is a wound protectant. Applied over a small cut, it protects the wound from further injury or contamination while providing a moist environment to heal. An anal fissure looks like a cut, but it is caused by the tissue being pulled apart. While Vaseline can provide symptom relief, the goal of anal fissure treatment is to keep the tear from being pulled apart. This is accomplished by softening the stools or relaxing the anal sphincter.
Do fissures itch when healing?
Itching is a common symptom of anal fissure, but it is not caused by the healing process.
Does coconut oil heal fissures?
Coconut oil is a moisturizer, so using it may help with moisture and lubrication. However, anal fissures are not caused by dry skin, and coconut oil will not treat them. Always follow the guidance of your healthcare provider regarding anal fissure treatment.
Can fissures get infected?
An anal fissure can get infected in some cases. If you have rectal bleeding or pain, you should see a healthcare provider.
Sources
Anal fissures, Cleveland Clinic (2023)
Anal fissure expanded information, American Society of Colon & Rectal Surgeons (2020)
Anal fissure, MedlinePlus (2026)
Anal fissures: Symptoms, causes, and treatment options, Harvard Health (2024)
Anal fissures, StatPearls (2025)
Anal fissures, UCSF Health
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