Gastro Health

Anal Fissure: Causes, Prevention, and Treatments.

Written by Dr. Mahmoud Ahmed Abelrahman Abouibrahim and medically reviewed by iCliniq medical review team.

Image: Anal Fissure: Causes, Prevention, and Treatments.

An anal fissure is a tear or ulcer that develops in the lining of the anal canal after passing a hard motion. Actually, it affects one in ten people at some point in their lives. All age groups and both sexes are affected equally.


  1. Constipation is the most common cause either by itself or as part of irritable bowel syndrome.
  2. Severe diarrhea.
  3. It may be part of a more serious condition such as Crohn's or cancer.
  4. Often there are no clear-cut reasons.

Signs and Symptoms

  • A sharp pain when you pass stools, often followed by a deep burning pain that may last several hours.
  • Bright blood is seen usually on the toilet paper.
  • It is commonly associated with severe constipation.

The Course of the Condition

Usually, it resolves over four to six weeks. But, it can recur if there is constipation or hard motion. In some people, the condition turns chronic and lasts for years. Few develop complications such as anal stricture and require surgery.

How to Prevent

  • Stay well hydrated.
  • Eat a lot of high-fiber foods such as green vegetables, fruits, and oats.
  • Exercise regularly.
  • Do not neglect the urge to pass motions.

How to Treat

  1. Treating constipation with laxatives and stool softeners is the main step.
  2. Glyceryl trinitrate ointment can be applied locally two to three times a day (this causes a headache which will require Paracetamol 1000 mg tablet) preferably at bedtime.
  3. Topical Lidocaine (anesthetic) is helpful in relieving pain.
  4. Sitz bath (sitting in a warm water bath) for 15 minutes once or twice a day.
  5. Botox injections every three months if medical therapy fails.
  6. Surgery is the last resort for few cases that do not respond to conservative management.
  7. In case other serious conditions are suspected, a referral to a specialist for further investigations is required.

For more information consult a medical gastroenterologist online -->

Last reviewed at: 07.Sep.2018


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Answer: Hello, Welcome to You seem to be having constipation related anal tear and hemorrhoids that can cause pain around anus.  I recommend the following to my patients after performing proctoscopy. Lignocaine 2% gel to be applied around the anus 15 minutes before passing stools. Smuth Ointme...  Read Full »

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