An anal fissure is a small tear or cut in the skin lining the anus. Symptoms include:

  • Extreme pain during bowel movements

  • Red blood, bleeding with bowel movements.

Causes of Anal Fissures

  • Hard dry bowel movements

  • Diarrhea

  • Inflammation

  • Trauma to the anus

  • Altered bowel habits

Once a cut forms, it causes the the muscle around the anal opening, (sphincter) to spasm. These spasms make it hard for the cut to heal and can cause pain to last for some time after a bowel movement.


An acute fissure (new onset) is treated without surgery. With improving bowel habits, the fissure may heal on its own. These changes include:

  • Eating a high fiber diet

  • Drinking more water

  • Taking stool softeners

  • Taking a bulk fiber such as Metamucil®

These changes allow you to pass soft stool and avoid constipation.

Take warm baths for 10-20 minutes several times a day to sooth and relax the anal muscles. Your doctor may also give you creams to help.

A chronic fissure (lasting more than a month or one that heals and comes back) may require surgery.

Types of Surgery

A sphincterotomy which involves a minor cut of the internal anal sphincter muscle. This treatment helps the fissure to heal by relaxing the sphincter and decreasing spasms.

The other type of surgery involves injecting Botox®, or a muscle relaxer, into the sphincter muscle to decrease the spasms.

You will need a few weeks to completely heal from these surgeries, but you will likely have less pain within a few days.

After Surgery

Take a sitz bath at least 3-4 times a day and after each bowel movement. A sitz bath is sitting in a bathtub of warm water for 10-20 minutes. This will help decrease the pain of muscle spasms and help you heal.

After surgery you may be told to take a stool softener (docusate sodium) and/or a bulk fiber laxative such as Metamucil® to prevent constipation. You can buy these without a prescription.

Please contact the clinic before resuming or starting any new creams near the surgical area.


  • Change your position from sitting to standing to lying down for comfort.

  • You may return to work when you feel ready.

  • No driving while taking prescription pain pills.

  • You may resume sex when you feel ready.

Follow Up

You will return to the clinic in 1-3 weeks.

When to Call

  • Large amount of bright red blood that does not stop with pressure to the area for 10 minutes.

  • Fever over 100.4º F for 2 readings, taken 4 hours apart. Check for a fever once daily at the same time each day for a week.

  • Foul-smelling drainage.

  • Excess swelling.

  • You cannot control bowel movements.

  • Trouble passing urine.

Who to Call

Digestive Health Center: 608-242-2800
After hours, weekends or holidays ask for the doctor on call. Leave your name and phone number with area code. We will call you back.
The toll-free number is: 855-342-9900.

If you are a patient receiving care at UnityPoint – Meriter, Swedish American or a health system outside of UW Health, please use the phone numbers provided in your discharge instructions for any questions or concerns.