Anal fissures

Additional information

Anal Fissures: A Complete Guide

Understanding anal fissures and how to manage them well. This guide covers what an anal fissure is, what causes it, how to recognise the symptoms, and the treatments that actually help. Whether you’re dealing with one right now, you’ve had recurrent fissures, or you’re trying to prevent them, we’ll walk through the facts, the treatments, and the practical day-to-day steps that make the biggest difference.

At Courier Pharmacy, we believe healthcare should suit the person, not the marketing budget. Anal fissures are common, treatable, and not something to be embarrassed about, but they sit in the kind of clinical territory people often delay talking about. This page is here to give you the honest, practical, evidence-based information you need to understand what’s happening, work out what to do, and know when to seek further help.

Five key takeaways

• An anal fissure is a small tear in the lining of the anal canal that causes sharp pain during and after bowel movements, often with a small amount of bright red bleeding
• Most fissures heal within 6 to 8 weeks with the right care, primarily focused on keeping stools soft and bowel movements comfortable
• Lifestyle changes (more fibre, more water, not delaying the urge, gentle hygiene, warm baths) are the foundation of treatment and prevent most recurrences
• Prescription treatments like GTN (glyceryl trinitrate) ointment or diltiazem cream help around 50 to 70% of patients heal when lifestyle measures alone haven’t been enough
• If a fissure hasn’t healed after 8 weeks of treatment, or if it keeps coming back, your GP can refer you to a colorectal specialist for further options including botulinum toxin injection or surgical treatments

What is an anal fissure?

An anal fissure is a small tear or split in the skin lining the lower part of the anal canal. Think of it like a paper cut, but in an area that gets stretched and irritated every time you have a bowel movement. The result is sharp, often searing pain during and immediately after passing stool, and frequently a small amount of bright red blood on the toilet paper or in the bowl.

Most anal fissures are acute, which means they appear, hurt for a few weeks, and heal up with sensible care. A smaller proportion become chronic, defined as lasting more than 6 to 8 weeks without healing or recurring repeatedly. Chronic fissures often need a bit more help to heal, including prescription treatments or occasionally a specialist procedure.

The good news is that most anal fissures heal completely with the right approach. The less good news is that they can be very uncomfortable while they’re healing, and the pain can be enough to affect your day-to-day life, work, sleep, and willingness to eat normally. Understanding what is happening and what to do about it makes a real difference to how the next few weeks go for you.

How common are anal fissures?

Anal fissures are more common than people often realise, partly because they sit in a category of conditions people are reluctant to talk about openly. Around 1 in 350 adults in the UK has an anal fissure at any given time, and roughly 1 in 1,000 people develop a new fissure each year. That means thousands of people across the UK are dealing with one right now.

Fissures affect people of all ages, but are slightly more common in younger and middle-aged adults, particularly between 15 and 40. They affect men and women roughly equally overall, although the situations that trigger fissures differ (pregnancy and childbirth in women, anal intercourse and certain bowel conditions across both groups).

The condition does not discriminate by overall health or lifestyle. People who are otherwise fit and well get fissures. People with chronic health conditions get fissures. Athletes get fissures. Office workers get fissures. The triggers are mostly mechanical (hard stools, straining, trauma) rather than constitutional, although certain conditions and circumstances raise the risk.

What causes anal fissures?

Understanding what caused your fissure is the first step to healing the current one and preventing the next one.

The dominant cause, by a wide margin, is passing a hard or large stool. When stool is too hard or too bulky to pass comfortably, the lining of the anal canal stretches beyond what it can stretch without damage, and a small tear results. The tear itself is painful, which makes you tense the muscles around your anus the next time you need to go, which makes the next bowel movement harder, which can deepen or re-open the tear. The cycle is self-reinforcing, which is why early intervention to soften stools matters so much.

Other established causes include:

• Persistent constipation of any cause, including dietary, medicine-related (opioid painkillers, some chemotherapy, iron supplements), and motility disorders
• Persistent diarrhoea, which can also damage the anal canal lining through repeated irritation
• Pregnancy and childbirth, particularly with prolonged second-stage labour, large babies, or instrumental delivery; postpartum constipation also contributes
• Inflammatory bowel disease, particularly Crohn’s disease (fissures are a recognised feature of perianal Crohn’s and warrant gastroenterology assessment if suspected)
• Anal intercourse without sufficient lubrication or with significant force
• Previous anal surgery or trauma affecting the local anatomy
• Skin conditions affecting the perianal area, including psoriasis, eczema, and lichen sclerosus
• Sexually transmitted infections affecting the anal canal, including syphilis, herpes, and chlamydia (lymphogranuloma venereum subtype)
• Tuberculosis or HIV, in rare cases
• Very rarely, anal or rectal cancer, which can present with non-healing fissure-like lesions

For most patients, the cause comes back to constipation or local trauma, and the management is straightforward. For a smaller proportion, an underlying condition is contributing and warrants assessment. Persistent or atypical fissures, fissures off the midline (most ordinary fissures sit at the 6 o’clock or 12 o’clock position on the anal canal), multiple fissures, or fissures associated with other symptoms (significant bleeding, weight loss, change in bowel habit) need GP review to rule out the less common causes.

What happens in your body when you have a fissure

When the lining of the anal canal tears, several things happen at once.

First, the tear itself is painful. The anal canal is densely innervated by sensory nerves, particularly below the dentate line (the boundary between the rectum and the anal canal proper). Every bowel movement stretches the area and triggers the pain receptors at the edges of the fissure.

Second, the muscles around the anus tighten in response to the pain. The internal anal sphincter (under involuntary control) and the external anal sphincter (under voluntary control) both increase their resting tone. This is the body’s natural protective reflex, but in the case of a fissure it is counterproductive. The increased sphincter pressure reduces blood flow through the small arteries supplying the anal canal lining, which means less oxygen and fewer healing factors reaching the area where they are needed.

Third, the next bowel movement is harder because the tightened sphincters resist opening, and the patient often delays going to avoid the pain, which means the stool sits longer in the rectum and becomes drier and harder. When the bowel movement does happen, the harder stool re-stretches the still-healing fissure and the cycle continues.

This three-part vicious cycle (pain, muscle tightening, reduced blood flow) is the key to understanding why fissures sometimes do not heal on their own and why the treatments that work focus on breaking the cycle. GTN ointment and diltiazem cream both work primarily by relaxing the internal anal sphincter, which reduces resting pressure, restores blood flow, and lets the tear heal. Lifestyle measures (fibre, hydration, not delaying) work primarily by keeping stool soft so the cycle never gets started.

Recognising the symptoms

If you have an anal fissure, the symptoms are usually quite distinctive. The combination of pain pattern, location, and timing makes the diagnosis easier than people often think.

The main symptoms are:

• Sharp, searing, or burning pain during a bowel movement, often described as feeling like passing broken glass or a razor blade
• A deep, throbbing or burning pain that persists for minutes to hours after the bowel movement is over
• Bright red bleeding, typically a small amount, noticed on the toilet paper, on the surface of the stool, or in the bowl
• A visible split or crack in the skin around the anal opening, sometimes felt as a small lump or tag at the lower end
• A reluctance to go to the toilet because of the anticipated pain, which often makes the constipation cycle worse
• Increased anal tone sometimes felt as tightness or spasm

The pain pattern is important diagnostically. Fissure pain is acute at the time of bowel movement and persists for some time afterwards, then settles until the next bowel movement. It is not constant aching pain (which suggests something else, like an abscess or other inflammatory condition). It is not pain that comes and goes randomly (which suggests other anal or rectal conditions).

The bleeding pattern is also important. Fissure bleeding is typically small amounts of bright red blood, noted on the paper or on the surface of the stool, not mixed through the stool. Blood mixed through the stool, dark or black stool, or significant amounts of bleeding warrants prompt GP review because these suggest bleeding from higher in the gut rather than from a local fissure.

It is worth being honest that the symptom pattern of anal fissure can overlap with other conditions: haemorrhoids (piles), perianal abscess, perianal Crohn’s disease, sexually transmitted infections of the anal canal, anal warts, dermatological conditions of the perianal skin, and rarely anal cancer. GP examination is the way to be sure what you are dealing with, particularly if the symptoms do not fit the classic fissure picture or if they are not settling with sensible self-care.

How are fissures diagnosed?

Diagnosis of an anal fissure is usually straightforward for a GP or experienced clinical pharmacist. The history (pain pattern, bleeding pattern, recent constipation or other triggers) is often diagnostic in itself.

Examination involves the patient lying on one side with knees drawn up towards the chest. The clinician gently parts the buttocks to inspect the anal opening. Most fissures are visible as a small linear tear, usually on the posterior midline (the 6 o’clock position when the patient is lying on their back) or less commonly on the anterior midline (the 12 o’clock position). A chronic fissure often has an associated skin tag at the lower end (sometimes called a sentinel pile) and may have a small bump at the upper end (a hypertrophied anal papilla).

Most fissures do not require digital rectal examination or internal examination at the first visit because the pain makes this very uncomfortable, and the inspection alone confirms the diagnosis. Internal examination may be appropriate later, when the fissure has healed, to ensure there is nothing else to find.

Investigations beyond clinical examination are usually not needed for typical fissures. They become relevant if:

• The fissure is in an atypical location (off-midline fissures warrant consideration of underlying conditions like Crohn’s disease, infection, or rarely cancer)
• There are multiple fissures
• The fissure is not healing with appropriate treatment
• There are systemic symptoms (weight loss, change in bowel habit, significant bleeding) suggesting something else
• The patient is young with strong family history of bowel cancer or inflammatory bowel disease

In these situations, GP referral to a colorectal specialist for further assessment (proctoscopy, sigmoidoscopy, or colonoscopy as appropriate) is sensible.

Can fissures be cured?

Yes. Most anal fissures heal completely with appropriate care, and the patient returns to normal bowel function without lasting effects. The healing timeline is:

• Acute fissures (less than 6 to 8 weeks): heal in 6 to 8 weeks with sensible self-care alone in around 50% of cases. Adding GTN or diltiazem cream pushes the healing rate higher, to around 70 to 80% within 8 weeks.
• Chronic fissures (more than 6 to 8 weeks): may need prescription treatments to heal. Around 50 to 70% heal with GTN or diltiazem over 6 to 8 weeks. Those that do not heal may need specialist intervention (botulinum toxin injection, surgical sphincterotomy, or other procedures).

The key principles are the same for all fissures: keep stool soft and comfortable to pass, break the sphincter spasm cycle, give the tissue time to heal, and address any underlying triggers. The fissure heals more quickly when you focus on these together rather than waiting for one to work in isolation.

Your prescriber will usually want to see you for follow-up at 6 to 8 weeks to confirm healing. If symptoms have not settled by then, the next step is either escalating treatment or referral for specialist assessment.

The important thing to remember is that healing takes time. The pain often improves in the first 1 to 2 weeks of consistent treatment, but full healing of the tissue typically takes longer. Stopping treatment as soon as the pain settles often leads to recurrence; continue for the full course your prescriber recommends.

Self-help strategies that genuinely make a difference

Before reaching for prescription treatments, there is a lot you can do at home that makes a real difference. For many patients with acute fissures, lifestyle measures alone are enough to heal the fissure within a few weeks. For patients with chronic fissures, lifestyle measures are still the foundation, with medical treatments added rather than replacing them.

Eating for better bowel health

Fibre is your best friend when you have an anal fissure. A higher-fibre diet keeps stool soft and bulky in a way that makes it easier and less painful to pass, reduces straining, and shortens the time the stool sits in the rectum drying out.

Aim for around 30g of fibre per day, ideally from food sources rather than supplements. Good sources include:

• Wholegrain bread, brown rice, wholemeal pasta, oats, bran-based cereals
• Beans, lentils, chickpeas, and other pulses
• Fruit, particularly with the skin on (apples, pears, berries, oranges)
• Vegetables, fresh, frozen, or tinned (without added sugar or salt)
• Nuts and seeds (chia, flaxseed, almonds, walnuts)

Increase fibre gradually rather than all at once, because a sudden jump in fibre intake causes bloating, wind, and abdominal discomfort that can put people off altogether. Add a portion or two of high-fibre food per day for the first week, then build from there. Drink more water as you increase fibre; the two work together.

If you find it difficult to reach 30g of fibre from food alone, a fibre supplement like ispaghula husk (Fybogel) or methylcellulose can help. These are bulk-forming laxatives that add to stool bulk without the cramping that stimulant laxatives can cause.

Staying hydrated

Drinking enough water matters as much as fibre. Aim for 6 to 8 glasses a day (roughly 1.5 to 2 litres), more in hot weather or if you exercise heavily. Stool is around 75% water in normal consistency, and hydration is one of the most modifiable factors that affects this. Caffeinated drinks and alcohol have a mildly diuretic effect, but in moderation they still contribute to overall fluid intake; the key is making sure water (or other non-caffeinated, non-alcoholic fluids) makes up the majority.

Not delaying the urge

This one matters more than people realise. When you feel the urge to have a bowel movement, go to the toilet then rather than waiting. The longer stool sits in the rectum, the more water is reabsorbed back into the body, and the harder the stool becomes. Delaying makes the next bowel movement more difficult, more painful, and more likely to re-injure the fissure.

For many fissure patients, the natural reaction is to avoid going because it hurts. This makes the problem worse, not better. Trust the urge and go.

Toilet position and not straining

Sitting in a slightly squatting position (with feet on a low footstool) aligns the anal canal more naturally for stool to pass and reduces the need to strain. The bowel reflex is most effective in the first 5 minutes; if nothing is happening after that, get up and try again later rather than sitting and straining.

If you find yourself reading on your phone for 15 minutes on the toilet, that is enough time for venous congestion to develop in the anal area, which can worsen both fissures and haemorrhoids. Keep toilet time short and focused.

Keeping the area clean and dry

Gentle hygiene after a bowel movement helps the area heal. Clean with warm water rather than soap (which can irritate the perianal skin), and pat the area dry rather than rubbing. Toilet paper can be too rough for an inflamed fissure; warm water with a bidet, a moist cloth, or unscented baby wipes (used gently) are kinder to the area.

After cleaning, pat dry thoroughly. Damp skin in the perianal area is more prone to irritation and infection. Some patients find a hairdryer on a cool setting useful for this.

Warm baths for symptom relief

Sitting in a warm bath after a bowel movement can be remarkably effective for pain relief. The warmth relaxes the anal sphincter, increases blood flow to the area (helping healing), and soothes the pain. Aim for 10 to 15 minutes in comfortably warm (not hot) water, two to three times a day if you can manage it, and particularly after each bowel movement.

You do not need to add anything to the water. Some people use Epsom salts; this is not particularly helpful but does no harm. Avoid bubble baths or scented additives, which can irritate the area.

Over-the-counter pain relief

Paracetamol is a sensible first-line for fissure pain. Take 1g (two 500mg tablets) up to four times daily, with at least 4 hours between doses and not exceeding 4g in 24 hours. Paracetamol does not cause constipation and is safe alongside fissure treatments.

Ibuprofen at 200 to 400mg three times daily can be added if paracetamol alone is not enough, but check that ibuprofen is appropriate for you (not in pregnancy, not with stomach problems, not with kidney problems, not with certain heart conditions). Topical anaesthetic ointments (lidocaine 5%) can also help with the immediate pain around bowel movements but only provide short-term relief.

Avoid opioid painkillers (codeine, dihydrocodeine, tramadol, morphine) for fissure pain. Opioids cause constipation, which is exactly what you do not want when you are trying to heal a fissure.

Medical treatments for anal fissures

If lifestyle measures alone are not enough, or if your fissure has been there for more than a few weeks, prescription treatments are the next step.

Laxatives and stool softeners

For patients with significant constipation contributing to their fissure, a stool softener or osmotic laxative can be added. Common options include:

• Ispaghula husk (Fybogel sachets): a bulk-forming laxative that adds water and bulk to stool. Available over the counter.
• Lactulose (Duphalac, Laevolac): an osmotic laxative that draws water into the bowel. Available on prescription or over the counter.
• Macrogol (Movicol, Laxido): an osmotic laxative that works similarly to lactulose but is often better tolerated.
• Docusate sodium: a stool softener that lubricates the stool. Available over the counter.

Avoid stimulant laxatives (senna, bisacodyl) as the main treatment for fissure-related constipation, because they can cause cramping and a sudden urgent need to pass stool, which is uncomfortable with a fissure. They are fine for occasional use but not for ongoing daily use in this situation.

Local anaesthetic ointments

Lidocaine 5% ointment applied to the anal canal before a bowel movement can numb the area and reduce the immediate pain. It does not heal the fissure itself but makes the bowel movement less painful and reduces the protective sphincter spasm response. Apply a small amount around 10 to 15 minutes before you anticipate going.

Local anaesthetic ointments are useful for short-term symptom relief while other treatments take effect. They are not a complete answer in themselves, particularly for chronic fissures.

GTN (glyceryl trinitrate) 0.4% ointment

Glyceryl trinitrate ointment (Rectogesic 0.4% rectal ointment in UK practice) is one of the most established prescription treatments for anal fissure. It works by relaxing the internal anal sphincter, which reduces resting anal pressure, restores blood flow to the fissure site, and allows the tear to heal.

The treatment course is typically 6 to 8 weeks of regular application. The standard regimen is a small amount (around 2.5cm of ointment) applied to the anal canal twice daily. Studies show GTN heals 50 to 70% of chronic fissures over an 8-week course, which is a meaningful improvement over placebo.

The main side effect is headache, which affects around 20 to 30% of users and can be significant in some. The headache reflects the systemic absorption of nitrate causing vasodilation. Strategies that help include applying smaller amounts, applying at a time of day that is not before sleep (so the headache does not affect rest), and taking paracetamol around 30 minutes before application. For patients who cannot tolerate the headache, diltiazem cream is the usual alternative.

GTN is contraindicated in patients on PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) used for erectile dysfunction, because the combination can cause dangerous hypotension. It is also generally avoided in pregnancy and in patients with severe heart failure, severe hypotension, or recent heart attack. The prescriber will confirm suitability.

Diltiazem 2% cream

Diltiazem cream is a calcium channel blocker that works similarly to GTN by relaxing the internal anal sphincter, but through a different mechanism. The healing rates are broadly comparable to GTN (around 50 to 70% over 6 to 8 weeks of regular application), and the side effect profile is generally more favourable, with less headache and fewer cardiovascular effects.

Diltiazem cream is not currently a licensed UK medicine in this strength and presentation, but it is widely used as a special (an unlicensed preparation made by specialist compounding pharmacies for individual patients on prescription). The off-label use is well-established in colorectal and general surgical practice.

Diltiazem cream is often the first-line choice for patients who have had headache with GTN, patients on nitrates for cardiovascular reasons (where GTN is contraindicated), and patients on PDE5 inhibitors. The application is similar to GTN: a small amount applied to the anal canal twice daily for 6 to 8 weeks.

Combined treatment

For many patients, the most effective approach is a combination of lifestyle measures, stool-softening medicines, local anaesthetic for immediate pain relief, and either GTN or diltiazem for sphincter relaxation. This combination addresses each part of the vicious cycle simultaneously and tends to produce faster and more reliable healing than any single treatment alone.

Treatments for stubborn or recurrent fissures

If a fissure has not healed after 8 weeks of medical treatment, or if it keeps coming back despite appropriate treatment, GP referral to a colorectal surgeon is the next step. The specialist will reassess the diagnosis (making sure there is no underlying condition that has been missed) and discuss further options.

Botulinum toxin injection

Botulinum toxin (Botox) injected into the internal anal sphincter produces several weeks to months of muscle relaxation, allowing the fissure to heal during that window. The injection is given as a day procedure, often under local anaesthetic, and the muscle relaxation develops over several days. Healing rates with Botox are typically 60 to 80% over 8 to 12 weeks.

The main advantage of Botox is that the muscle relaxation is temporary, so the long-term risk of incontinence (which is the main concern with surgical sphincterotomy) is much lower. The main disadvantage is cost and the need for a repeat procedure if the fissure recurs.

Lateral internal sphincterotomy

This is a small surgical procedure in which the surgeon makes a controlled cut in part of the internal anal sphincter, releasing the muscle tension that has been preventing healing. Healing rates are very high (around 90% or more) and the procedure is one of the most effective treatments for chronic fissures.

The trade-off is the small but real risk of altered continence afterwards. Most patients have no lasting continence issues, but a minority report some difficulty controlling wind or, less commonly, mild faecal soiling. This is why sphincterotomy is usually reserved for fissures that have not responded to medical treatment, and why surgeons carefully select patients for whom the benefits outweigh the risks.

Fissurectomy

Less commonly used than it once was, fissurectomy involves surgically excising the edges of the chronic fissure to convert it into a fresh wound that can heal. It is sometimes combined with botulinum toxin injection or sphincterotomy. Healing rates are similar to sphincterotomy with a slightly different side effect profile.

Advancement flap

For very chronic, complex, or recurrent fissures, an advancement flap procedure brings healthy tissue from above the dentate line to cover the fissure site, allowing it to heal under more favourable conditions. This is a specialist procedure used in selected cases.

The choice between these procedures depends on the individual patient, the surgeon’s experience, the patient’s age and continence baseline, and the patient’s preferences. The colorectal team will work through this with you.

Preventing recurrent fissures

Once a fissure has healed, the natural question is how to stop it happening again. The principles are essentially the same as the treatment principles, applied as long-term lifestyle habits:

• Eat plenty of fibre every day (around 30g)
• Drink enough water (6 to 8 glasses daily)
• Exercise regularly, even just a 20 to 30 minute walk most days helps bowel motility
• Do not delay the urge to go to the toilet
• Do not strain or spend extended time on the toilet
• Keep the perianal area clean and dry with gentle hygiene
• Address any medicines that are contributing to constipation (talk to your prescriber about alternatives)

If you have an underlying condition that raises your fissure risk (Crohn’s disease, irritable bowel syndrome, chronic constipation from any cause), good management of that condition reduces the fissure risk. Work with your GP on the wider picture.

For patients with a history of recurrent fissures, ongoing low-dose stool softeners (lactulose, macrogol, or ispaghula husk) may be appropriate. Some patients find a daily probiotic or kefir helpful for stool consistency, although the evidence is mixed.

Frequently asked questions

How long does an anal fissure take to heal?

Most acute fissures heal in 6 to 8 weeks with appropriate care. Some heal more quickly, particularly with early treatment. Chronic fissures (lasting more than 6 to 8 weeks) may take longer and sometimes need specialist treatment.

Is an anal fissure serious?

No, anal fissures are not serious in the medical sense. They are not life-threatening and they do not lead to other major complications. That said, they can be very painful and affect quality of life, so they deserve proper treatment.

Is it contagious?

No, you cannot catch an anal fissure from someone else, and you cannot pass one on. The exceptions are fissures caused by certain sexually transmitted infections (where the infection itself is transmissible) or fissures in the context of perianal Crohn’s disease (which is not contagious but is a chronic condition that needs ongoing management).

Will my fissure come back?

Some people have one fissure and never another. Others are prone to recurrence. The risk depends on your underlying triggers (constipation, dietary patterns, bowel habits) and how well these are managed. Sustained lifestyle changes after the first fissure significantly reduce the risk of recurrence.

Should I see a doctor if I am bleeding from my bottom?

Yes, anal bleeding should always be assessed by a GP, even when you suspect a fissure. While most bleeding from a fissure is small amounts of bright red blood on the paper, similar bleeding patterns can occur with haemorrhoids, polyps, inflammatory bowel disease, and rarely bowel cancer. GP examination confirms the diagnosis and rules out other causes.

Can I exercise with a fissure?

Yes, but adjust to comfort. In the acute phase, very heavy lifting or activities that increase intra-abdominal pressure significantly may exacerbate the pain. Gentle to moderate exercise (walking, swimming, cycling at moderate intensity, light yoga) is generally fine and helps prevent constipation. Heavy weightlifting may need to be paused for a few weeks.

What is the difference between an anal fissure and piles?

Anal fissures are tears in the lining of the anal canal. Piles (haemorrhoids) are swollen blood vessels in or around the anus. They can both cause pain and bleeding and they sometimes occur together. The pain pattern is different: fissure pain is sharp and timed to bowel movements; haemorrhoid pain is often more throbbing and constant, particularly with thrombosed external haemorrhoids. GP examination distinguishes between them.

Can pregnancy cause anal fissures?

Yes. Pregnancy raises the risk through several routes: pregnancy-related constipation (very common), pressure on the perineum during pregnancy, the physical stress of vaginal delivery, and postpartum constipation. If you develop a fissure during pregnancy or postpartum, tell your GP or midwife; some treatments are not suitable in pregnancy (GTN is generally avoided), but lifestyle measures, fibre, hydration, and local anaesthetic are usually fine.

Are there foods I should avoid?

There is no specific food list to avoid. The principle is to favour fibre-rich foods over highly processed ones, and to drink enough water. Spicy food does not cause or worsen fissures (despite the folklore). Some people find that very dehydrating foods or beverages (excess caffeine, excess alcohol) worsen their constipation and should be moderated.

Can stress make fissures worse?

Stress can affect bowel habits, often making constipation or diarrhoea worse, both of which can contribute to fissure risk or impede healing. Managing stress through whatever works for you (exercise, sleep, time with people who matter, professional support if needed) is genuinely helpful for bowel health.

When should I worry that it might be something more serious?

Most fissures are exactly that, with no underlying sinister cause. Seek prompt GP assessment if you have:

• Significant bleeding (more than a small amount on the paper)
• Dark or black stool, or blood mixed through the stool
• Unexplained weight loss
• A change in your usual bowel habit lasting more than a few weeks
• A family history of bowel cancer
• Symptoms that do not fit the typical fissure pattern (constant pain, pain not related to bowel movements, multiple lesions)
• A non-healing fissure off the midline (most ordinary fissures are at 6 or 12 o’clock; off-midline fissures warrant assessment)

Looking ahead

Research into anal fissure treatment continues to develop, with newer topical formulations, refinements in surgical technique, and a better understanding of the role of biofeedback and pelvic floor work in selected patients. If you have a chronic fissure that has not responded to standard treatment, ask your GP or specialist about newer options or clinical trials you might be eligible for.

The key takeaway is that anal fissures are common, treatable, and usually heal well with the right approach. You do not have to suffer through this alone, and you do not have to be embarrassed about seeking help. Your GP, a colorectal specialist, or our team at Courier Pharmacy can help you find the right approach for your situation.

More than a prescription: our community

Healthcare shouldn’t only happen when you’re paying for it. Every fortnight we run free drop-in talks and clinics at Insomnia, Derby, from 12pm to 1pm. Bring a question, bring a friend, bring a stack of bewildering letters from another clinic; we’ll sit with you. We cover bowel health, anal fissures, haemorrhoids, IBS, IBD, MCAS, hair loss, men’s health, weight management, and whatever else people bring through the door. No appointment. No cost. No pressure. Learn more about our community talks.

Disclaimer: This article is for information only and isn’t a substitute for personal medical advice. Always speak to a qualified prescriber before starting or changing treatment.

How this content was created

Written by the Courier Pharmacy editorial team and reviewed by a GPhC-registered pharmacist. Grounded in the latest NHS, NICE, BNF, and EMC guidance, peer-reviewed studies, and the real questions patients bring to our drop-in clinics in Derby.

References

[1] NHS (2024) Anal fissure. Available at: https://www.nhs.uk/conditions/anal-fissure/

[2] NICE Clinical Knowledge Summaries (2024) Anal fissure. Available at: https://cks.nice.org.uk/topics/anal-fissure/

[3] NICE Clinical Knowledge Summaries (2024) Anal fissure: Goals and outcome measures. Available at: https://cks.nice.org.uk/topics/anal-fissure/goals-outcome-measures/

[4 Electronic Medicines Compendium (emc) (n.d.) Rectogesic 4 mg/g rectal ointment — Summary of Product Characteristics (SmPC). Available at: https://www.medicines.org.uk/emc/product/1373/smpc