Anal Fissure
A small tear in the anal lining that causes sharp pain and bleeding during bowel movements.
An anal fissure is a small tear in the thin lining of the anus, usually caused by passing a hard or large stool. It produces a sharp, tearing pain during a bowel movement and often a streak of bright red blood. Most fissures heal with fibre, ointments and warm baths; stubborn ones are cured with a quick laser procedure.
An anal fissure is a small problem that can cause big discomfort. The sharp pain during and after a bowel movement can make people dread going to the toilet, which in turn worsens constipation and keeps the fissure open. With the right care, most fissures heal quickly — and even long-standing ones can be cured with a simple, low-pain procedure.
एनल फिसर भनेको गुदाद्वारको भित्री छालामा पर्ने सानो चिरा हो, जसले दिसा गर्दा तीव्र दुखाइ र रक्तस्राव गराउँछ; धेरैजसो औषधि र फाइबरले निको हुन्छ भने जिद्दी अवस्थामा लेजर उपचार गरिन्छ।
Understanding Anal Fissure
An anal fissure is a tear or split in the delicate lining (anoderm) of the anal canal. It most often occurs at the back of the anus when a hard, dry or large stool is forced through. The tear exposes the underlying muscle, which then goes into a tight spasm — and this spasm both causes intense pain and reduces blood flow, making the fissure slow to heal.
A fissure lasting less than six weeks is called acute and usually heals with simple measures. One that persists longer is chronic, and may show a small skin tag (sentinel pile) at its outer edge and thickened tissue at its base.
Symptoms
- A sharp, burning or tearing pain during a bowel movement
- Pain that can continue for minutes to hours afterwards
- A streak of bright red blood on the stool or toilet paper
- A visible small tear or crack in the skin around the anus
- A small lump or skin tag near the tear (in chronic fissures)
- Spasm and tightness of the anal muscle
Causes & risk factors
- Passing hard or large stools due to constipation
- Chronic diarrhoea and repeated straining
- A low-fibre diet and inadequate fluid intake
- Childbirth and the strain of pregnancy
- Tight or over-active anal sphincter muscle
- Underlying inflammatory bowel disease (less commonly)
Possible complications
- A chronic, non-healing fissure that recurs repeatedly
- Ongoing pain that disrupts daily life and toilet habits
- A sentinel skin tag at the edge of the fissure
- A cycle of fear, constipation and worsening tears
- Rarely, formation of a small fistula if infection develops
How it is diagnosed
An anal fissure is usually diagnosed by history and a gentle inspection of the anus — the tear is often visible by simply parting the skin. Because internal examination can be painful during an acute fissure, Dr. Sujan Shrestha keeps the assessment gentle and, when needed, defers a deeper examination until the pain has eased or the patient is comfortable.
Treatment options
Most acute fissures heal with conservative treatment: a high-fibre diet, plenty of water, stool softeners, warm sitz baths, and medicated ointments (such as those that relax the anal muscle and improve blood flow). Relieving constipation and the muscle spasm allows the tear to close naturally. When a fissure becomes chronic and does not heal despite these measures, a procedure is the reliable next step.
Surgical treatment
For chronic or recurrent fissures, Dr. Sujan Shrestha offers laser treatment, a precise, minimally invasive option that promotes healing and relieves the muscle spasm with very little pain and no large wound. In selected cases, a lateral internal sphincterotomy — a small, controlled release of the tight muscle — remains a highly effective, time-tested cure. The right approach is chosen to heal the fissure while protecting normal bowel control.
Recovery & aftercare
Recovery after a fissure procedure is usually quick. Most patients go home the same day and notice that the severe spasm pain eases soon after. Keeping stools soft with fibre and fluids, taking warm sitz baths and following prescribed care help healing, which is typically complete within a couple of weeks. Normal activities can usually resume within a few days.
When to see a doctor
See a doctor if anal pain and bleeding during bowel movements last more than a week or two, or keep coming back. Seek care sooner if the pain is severe, the bleeding is heavy, or there is swelling, discharge or fever, which may point to infection or another condition that needs treatment.
Frequently asked questions
Many acute fissures heal within a few weeks with a high-fibre diet, more fluids, stool softeners and warm baths. A fissure that lasts longer than six weeks or keeps returning usually needs medical treatment or a small procedure to heal fully.
The tear exposes sensitive tissue and triggers a tight spasm of the anal muscle. This spasm causes the sharp pain and also reduces blood flow to the area, which is why fissures can be slow to heal without treatment.
Laser treatment is designed to be gentle on the sphincter and aims to heal the fissure while preserving normal bowel control. Your surgeon will choose the technique best suited to your fissure to protect continence.
Preventing constipation is key: eat plenty of fibre, drink enough water, avoid straining and do not delay going to the toilet. These habits keep stools soft and greatly lower the chance of a fissure returning.
A fissure itself is not cancer, but persistent anal pain and bleeding should always be examined to rule out other causes. Occasionally an untreated fissure can become infected or lead to a small fistula, so timely care is best.
Get a clear answer from a specialist
Dr. Sujan Shrestha (MBBS, MS, MCh) offers evidence-based, minimally invasive care for anal fissure and the full range of GI conditions.