Anal Fissure Causes, Symptoms, and Treatment
A comprehensive guide to anal fissure: why it causes severe pain, how it's distinguished from haemorrhoids, and its treatment options from conservative to surgical.
In this article
An anal fissure is a small tear in the lining of the anal canal, but despite its small size it may cause severe pain exceeding what many imagine. It's often confused with haemorrhoids due to some similar symptoms, but they are completely different conditions in cause and treatment. Understanding the fissure's nature helps treat it effectively and eliminate its bothersome pain. Fissure treatment is part of general surgery, and sometimes relates to haemorrhoids.
What Is an Anal Fissure and Why Does It Hurt So Much?
An anal fissure is a small tear or cut in the thin skin lining the anal canal. The reason for the severe pain is that this area is very rich in nerve endings, so any tear in it produces sharp pain like burning or cutting, especially during and for hours after bowel movements. The problem is that pain causes spasm in the sphincter muscle, and this spasm reduces blood flow to the area and hinders fissure healing, so the condition enters a vicious cycle of pain, spasm, and non-healing.
Anal Fissure or Haemorrhoids?
Signs Favouring Anal Fissure
- Sharp pain like burning or cutting during and after bowel movements.
- Pain is severe, distinctive, and lasts hours after bowel movements.
- A small amount of bright red blood on tissue.
- Spasm and tightness in the anal area.
Signs Favouring Haemorrhoids
- Often without severe pain (especially internal) or less sharp pain.
- Bleeding may be heavier, sometimes prolapse or a lump.
- Itching, irritation, and discomfort.
- Swelling or protrusion may be noticed in the area.
Causes of Anal Fissure
The most common cause of anal fissure is the passage of hard, large stool that tears the anal canal lining, directly related to chronic constipation. So constipation is the first enemy. Other causes include chronic diarrhoea, repeated straining during bowel movements, and sometimes childbirth in women. The common denominator with many digestive and hernia problems is the role of constipation, so treating it is the foundation of both preventing and treating fissures, just as its role in haemorrhoids.
Most anal fissure cases begin with constipation and persist because of it. Treating constipation with fibre, fluids, and stool softening is the cornerstone in breaking the cycle of pain and spasm, allowing the fissure to heal. Preventing constipation prevents fissures and their recurrence.
Treatment of Anal Fissure
Most acute (recent) fissure cases heal with conservative treatment: treating constipation with fibre, fluids, and laxatives, warm sitz baths to relax the muscle and improve blood flow, and topical ointments that relax the sphincter, ease pain, and aid healing. A chronic fissure (persisting for weeks despite treatment) may need greater intervention, like certain injections or a simple surgical procedure that relaxes part of the sphincter to break the spasm and allow final healing. The doctor determines what's best for your case.
"An anal fissure is a small condition with big pain, but among the most responsive to treatment when we break the cycle of constipation and spasm. I always reassure my patients: most cases heal without surgery, and the key is treating constipation and patience for healing."
Dr. Mohamed EsmatFrequently Asked Questions
How do I distinguish a fissure from haemorrhoids?
A fissure causes distinctive sharp pain like burning during and after bowel movements, while haemorrhoids are often less painful with bleeding or prolapse. Medical examination settles the diagnosis.
Does an anal fissure always need surgery?
No, most recent cases heal with conservative treatment and treating constipation. Surgery is reserved for chronic resistant cases only.
How long does a fissure take to heal?
An acute fissure may heal within weeks with proper treatment and treating constipation. A chronic one needs longer and sometimes additional intervention.
Suffering Severe Pain During Bowel Movements?
Book your consultation with Dr. Mohamed Esmat in a respectful professional environment for accurate diagnosis and effective treatment.
Dr. Mohamed Esmat
Consultant hernia and abdominal wall surgeon, PhD in General Surgery and founder of Hernia Core — the first Arab clinics dedicated to hernia surgery. 15+ years of experience and over 5,000 successful cases.
This article is for general medical awareness only and does not replace a consultation with a specialist. To assess your case, please book with Dr. Mohamed Esmat. Last reviewed: September 28, 2026.
