Overview

An anal fissure is a small crack or tear in the skin of your anus (where poo leaves your bottom). It is often very painful and might bleed, especially when going to the toilet (opening your bowels). 

Many fissures heal by themselves. Some people need treatment with creams or sometimes surgery which can take several months for symptoms to resolve.

Symptoms of an anal fissure

The main symptoms are a sharp pain when going to the toilet. This can be followed by a burning pain, which can last several hours. 

Also, you might notice small blood spots in your poo or on the toilet paper. 

Causes of an anal fissure

If you are constipated (when your poo is dry and you find it difficult to have a poo), this can cause an anal fissure. You can also get an anal fissure after having severe diarrhoea. 

Sometimes the cause is not known.

Treatment

Many fissures heal by themselves. You can also:

• increase the amount of fibre in your diet to help to keep your poo soft. High-fibre foods include muesli, brown rice or pasta, prunes and other fruit and vegetables.
• use painkillers such as paracetamol or ibuprofen. 
• use medicated creams (containing glyceryl trinitrate (GTN) or diltiazem) to try to heal your fissure and ease any pain.  

A referral for an examination under anaesthetic (EUA) may be necessary if the diagnosis is unclear or examination is too painful.

Sometimes a fissure does not heal and becomes a long-term (chronic) problem. In some cases, surgery is the best treatment option for an anal fissure. 

Your surgeon talks to you about the different treatment options, and what is the best treatment for you. 

Risks of surgery

Your surgeon discusses the possible risks with you before asking you to sign a consent form. 

The main risk is that surgery involves weakening some of your anal sphincter muscles. These are important for opening and closing your bowels. 

You might lose some of your control to hold your wind or poo. This could be a temporary or long-term problem. 

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have surgery, you will be asked to sign a consent form. This says that you agree to have the treatment and understand what it involves. 

If you would like more information about our consent process, speak to a member of staff caring for you.