What an anal fissure is
An anal fissure is a painful tear in the skin around the anus and the lower anal canal. It most often follows the passage of a hard, bulky stool, but prolonged diarrhoea, childbirth and other events that stretch the area can cause one too. The tear is usually only a few millimetres long, yet the pain it produces is out of all proportion to its size.
The reason lies in the muscle directly beneath the tear. Pain makes the internal anal sphincter go into spasm, spasm reduces blood flow to the area, and poor blood flow prevents the tear from healing. That self-sustaining cycle explains why a fissure does not simply close on its own and why symptoms can drag on for months. It also explains the logic of treatment: the aim is not just to heal the wound but to break the spasm so that healing becomes possible.
Symptoms: acute and chronic fissures
The hallmark symptom is sharp, cutting pain during a bowel movement, often described as passing broken glass. The pain begins with defaecation and then settles into a burning ache that can last minutes or hours afterwards. The second most common symptom is a small amount of bright red blood on the paper or on the surface of the stool. Itching and local irritation may accompany both.
Fissures present for less than about eight weeks are considered acute, and most heal with appropriate treatment. Beyond that they become chronic: the edges thicken, a skin tag may form outside and a small tag inside. Chronic fissures respond less well to medical treatment, and surgery is discussed more often.
Many people wait a long time before seeking help, which is particularly unhelpful with this condition. Pain makes patients avoid opening their bowels, stool becomes harder, and the tear is re-injured. Coming in early makes it far more likely that treatment stays at the level of ointments and diet.
Diagnosis
The diagnosis is usually made from the history and a careful examination. The characteristic relationship between pain and bowel movements is itself strongly suggestive. The area is examined gently; if pain makes a full examination impossible at the first visit, treatment to settle the pain is started and the examination is completed later when it is comfortable.
Some features prompt a wider look. Fissures in unusual positions, multiple fissures, or those that fail to respond to treatment raise the possibility of other conditions, particularly inflammatory bowel disease. We also check whether an abscess or fistula has developed in the same area. Where there is a change in bowel habit, weight loss or age-related risk, assessment of the colon may be arranged.
Non-surgical treatment
Acute fissures are almost always treated without surgery first, and every part of that treatment is aimed at breaking the pain-spasm cycle. Softening the stool comes first: more fibre, adequate fluid, and stool softeners if needed. A softer stool stops the wound being re-injured every day.
Warm sitz baths several times a day relax the sphincter and reduce pain. Alongside these, topical ointments that relax the internal sphincter are prescribed; by improving blood flow to the area, they give the tear a chance to heal. They can cause temporary side effects such as headache, and the duration of use is set by your surgeon.
In selected patients who do not respond to ointments, injecting botulinum toxin into the internal sphincter can be used to reduce the spasm temporarily. Which of these approaches suits you depends on how long the fissure has been present and what the examination shows.
Surgical treatment
Surgery is considered for chronic fissures, those that have not responded to medical treatment, and those that keep recurring. The goal is to relieve the severe pain and bleeding the tear causes, and these procedures can often be performed under local anaesthesia.
The most commonly used operation divides a limited portion of the internal anal sphincter. Relaxing the muscle restores blood flow to the area and allows the fissure to heal. How much muscle is divided is planned carefully. The chance of affecting control of gas or stool is low but not zero, so women who have given birth, older patients and anyone with existing continence concerns are assessed with particular care. In some patients an approach that avoids dividing the muscle, such as excising the fissure or covering it with a skin flap, is preferred.
There is no single default operation. The choice is made from the characteristics of the fissure and your own risk profile, discussed with you before anything is decided.
Recovery, prevention and care at İzmir Cerrahi Merkezi
A clear reduction in pain is usually noticed soon after surgery, although complete healing of the wound can take several weeks and varies from patient to patient. During recovery, a high-fibre diet and plenty of fluid are advised to keep bowel movements easy and reduce the risk of the tear reopening. Sitz baths are continued for a period, and follow-up visits confirm that healing is progressing.
Long-term success depends largely on keeping constipation under control for good. Not sitting on the toilet for long periods, not straining, and not postponing the urge are simple habits that make a real difference.
At İzmir Cerrahi Merkezi, anal fissures are managed in steps: non-surgical options are explored first, and surgery is proposed when it is genuinely indicated, with the reasoning explained. We are based at Güneşli Mah. 507 Sok. No: 3, Konak, İzmir. For an appointment, call 0538 508 3872.
Frequently asked questions
Can an anal fissure heal on its own?
Many recently developed fissures heal within a few weeks once the stool is softened and the sphincter spasm is reduced. The difficulty is that pain makes people avoid opening their bowels, which keeps the cycle going. If symptoms have lasted more than a few weeks, it is better to be assessed than to keep waiting.
How do I tell a fissure from haemorrhoids?
Pain is the most useful clue. A fissure causes sharp pain that starts with the bowel movement and lingers afterwards, whereas internal haemorrhoids are usually painless and cause bleeding and prolapse instead. The two can coexist, so the distinction is confirmed on examination.
Will fissure surgery affect my continence?
When only a limited portion of the internal sphincter is divided, the risk of a lasting effect on control of gas or stool is low, though not absent. Risk is assessed individually, and obstetric history, age and any pre-existing continence problems influence which technique is chosen. This is discussed openly before surgery.
Can I avoid surgery altogether?
For acute fissures, non-surgical treatment is the first choice and is enough for many patients. Chronic fissures respond less reliably to ointments. How long your symptoms have been present and what the examination shows determine which group you fall into.
Can a fissure come back after treatment?
Recurrence is most common when constipation persists. Fibre, adequate fluids, regular activity and sensible toilet habits are the most effective ways to reduce that risk.
Is the examination painful?
A fissure is painful, so the examination is done gently and in stages. If pain prevents a full assessment at the first visit, treatment is started to settle the symptoms and the examination is completed once you are more comfortable.