If you’ve suffered from hemorrhoids consistently, you are no stranger to the signs and symptoms of an anal fissure. The two share many common causes and may even be mistaken for one another without closer examination. Keep reading to learn how to compare hemorrhoids vs anal fissure, methods for treatment and prevention and how to heal a fissure fast once you’re sure you have one!
Who are we? We’re Doctor Butler’s, experts in down-there care of hemorrhoids and related conditions. We make proctologist-developed hemorrhoid ointments and complementary products to help you quickly leave the pain behind. Dr. Robert Cutler medically reviews all of the information here.
What are Fissures?
Anal fissures typically begin as smaller tears in your anal canal that grow into a more significant wound. As the skin around the anus is highly sensitive, it is susceptible to tearing, particularly when it is stretched beyond its usual capacity. Normally such cuts easily heal, but the combined sensitivity and pressure on the lower intestine can lead to a cycle of re-injury that prevents recovery, causing a fissure.
The location of a fissure is what differentiates it from other health concerns in the region. As fissures occur along the anal canal, they expose the internal sphincter muscle below, causing it to spasm. The ensuing pain is similar to that associated with hemorrhoids, which is why a careful examination is necessary to avoid misdiagnosis. These spasms may continue to reopen the tear, leading to a chronic fissure. Acute anal fissures last less than six weeks1, and chronic fissures form from the continued recurrence of an acute fissure.
Common Causes of Anal Fissures
What causes anal fissures? There are a number of factors that contribute to their formulation. The following is a list of some of the more common culprits.
- Constipation – Hard, dry stools that you must strain to pass put pressure on the anal canal, stretching it to accommodate the affected bowel movement and tearing the skin. Attempting to prevent or hold-in bowel movements to avoid exacerbating an existing fissure will only prolong healing.
- Diarrhea – Stool being rapidly propelled through the anal canal is at risk of rupturing the skin, and loose, runny stool may further irritate fissures already present.
- Childbirth – 40% of pregnant women will experience postpartum fissures2. Constipation during pregnancy, rising weight, labor and delivery all add immense pressure to the lower intestinal area. Internal factors such as increased progesterone can leave the body prone to swelling3.
- Aging – As blood flow decreases with age4, it affects sensitive areas that rely on steady circulation to remain healthy, including your anal lining. Decreasing strength of connective tissue and veins in the region also increases the risk of tearing.
- Inflammatory Bowel Disease (IBD) – IBD is the name for two conditions (Chron’s disease and ulcerative colitis) that cause chronic inflammation of the gastrointestinal tract. This inflammation can extend to the lower intestine, leaving the anal lining more susceptible to tearing.
- Sexually Transmitted Infections (STI) – Certain STI’s can lead to fissures as an indirect result of associated symptoms (inflammation and irritation of the rectal mucosa).5,6
- Preexisting Fissures – Just as chronic fissures form from an acute fissure that reopens or has difficulty healing, preexisting fissures leave the anal mucosa weaker and more susceptible to tearing.
Symptoms and Diagnosis
If there is a silver lining to discovering your anal fissure symptoms, it’s that you can now do something about it. Pain is the most common symptom to be aware of. Pain was present in 90.8% of patients suffering from a fissure in a study of 876 subjects7. Pain from fissures can start at the moment of defecation but has the potential to last for extended periods of time following the bowel movement.
Blood is another common symptom. Blood is often found on toilet paper, streaked along stool or as droplets in the toilet bowl. As with most wounds, the healing process can mean the area is frequently itchy, especially as the fissure cycles through mending and reopening.
Pain and blood can sometimes be mistaken for a hemorrhoid itself, and not a simple fissure, or tear in the skin. Another feature of chronic fissures is that they’re often mistaken for external hemorrhoids is a skin tag (or sentinel pile)8. As a result of the fissure, the sensitive skin surrounding the wound becomes inflamed and forms a skin tag similar in appearance to that of the stretched skin overlaying a swollen external hemorrhoid. They may be painless, or they can cause sharp pain during bowel movements. Skin tags formed as a result of chronic fissures should not be removed until the fissure is healed.
As you may have noticed, there are many overlapping symptoms between anal fissures and hemorrhoids. While the two also share some common treatment methods, they are separate conditions that can indicate different, more serious underlying causes. Correctly diagnosing an anal fissure beyond identifying symptoms can involve a physical examination. A digital or anoscopic examination may be used to rule out other pathologies or to ensure there is no further infection.
At-Home Remedies for Fissures
Identifying an anal fissure is the first step to beginning anal fissure treatment. Early interventions have been proven to help speed up recovery, and at-home fissure treatment methods effectively increase anal fissure healing time. These convenient, cost-effective and proven strategies help fissures heal naturally and allow for immediate relief while planning long-term strategies for prevention. Failing to heal a fissure with these methods may also indicate that it is time to seek medical intervention.
Warm Sitz Baths
A sitz bath involves soaking the affected region in warm, shallow water. You can purchase a plastic basin to attach to your toilet, or simply fill your bathtub a few inches. Fissures put your anal sphincter under stress by causing spasms and preventing blood flow to the area. The warm water of a sitz bath, mixed with epsom salt, relaxes the muscle and encourages blood back to the lower intestine. It also reduces the pain and itching that accompany a fissure as it heals, decreasing the risk of reopening the tear.
Over-the-Counter Solutions
There are a variety of over-the-counter methods for treating anal fissures. If you’re struggling with constipation, stool softeners can help prevent further irritation to a fissure by increasing the amount of water a bowel movement absorbs before exiting. Fiber supplements (such as psyllium or methylcellulose) may also aid in the management of chronic constipation.
Topical ointments and creams contain ingredients that work to increase blood flow and minimize symptoms. Calcium channel blockers such as diltiazem and nifedipine and the pharmacological agent glyceryl trinitrate (a group of medicine known as topical vasodilators) all help reduce anal resting pressure9. Topical anesthetics, such as lidocaine, are used to reduce pain by blocking signals to sensitive nerve endings in the area. Prescribing a narcotic for the pain is typically discouraged, as a common side effect is constipation10.
In short, a mix of lidocaine and protective agents are what we’ve found work best. Find it in our ointment for fissures here.
H&F ointment
Excellent fast relief…excellent product
Verified ReviewerDietary Adjustments for Healing a Fissure
As our diets play a large role in the composition of our bowel movements, they directly impact how successfully a fissure heals. More importantly, they also enable a measure of prevention. Adjustments to diet can be a powerful tool in keeping the interwoven systems that affect our digestive and gastric health in check. Keep reading to learn more about dietary remedies to heal a fissure.
Fiber-Rich Diet
Both types of fiber play an important role in making sure your stool passes through your body with ease and without causing stress to the sensitive lining of your anus. Insoluble fiber provides bulk by sweeping out the contents of your bowels, while soluble fiber helps absorb water to form a gel-like substance that improves stool consistency and movement. Adding any amount of fruit, vegetables and whole grain foods to your meals adds both and will help ensure you’re sending fiber where it counts.
Hydration
Just like fiber, consuming the proper amount of fluids will help prevent your stools from creating an issue upon exit. When your colon does not contain enough water, dry stool becomes sticky and forces additional strain and pressure on your body to release it, leading to fissures and other issues. Drinking enough water helps your colon efficiently do its job and keeps stools bulky and soft.
Foods to Avoid
It’s important to remember that not all food and beverages are created equal when it comes to dietary adjustments for healing fissures. Foods that can upset your stomach or irritate an existing fissure should be avoided. These include processed and fried food, spicy food, dairy and excess sugar. Beverages with caffeine or alcohol can cause dehydration, counteracting a healthy digestive system and risking the reopening of healing fissures.
Medical Interventions for Fissures
While most fissures can be effectively healed with at-home treatments, it’s important to keep an eye out for signs a fissure is healing. If you are still experiencing pain, seeing blood or have a fissure that continues to reopen after six weeks, it’s time to seek medical attention. A colon and rectal surgeon can assess your fissure and recommend one of a few different medical interventions. Find out more on these procedures below.
Botox and Other Injections
The main goal in healing fissures is to reduce internal anal sphincter spasms11. Botox injections offer a means to cut-off the spasms without surgery, particularly for chronic fissures with no additional complications. Injecting the botox near or into the internal sphincter muscle has a paralyzing effect, halting the spasms and allowing blood flow to return to the area and begin healing the fissure. The injection is a same-day procedure usually performed under a local anesthetic.
Surgical Options
Surgery, as with most medical conditions, is considered a last-resort option for anal fissures. Just like botox injections, the goal of the procedure is to stop the anal sphincter from spasming. A lateral internal sphincterotomy achieves this by exposing the internal fibers of the anal sphincter and then surgically dividing it via a small incision. The procedure takes approximately 15 minutes and about 6 weeks for the anus to completely heal.
What is the fastest way to heal after fissure surgery? There may be some amount of bleeding and discharge after the procedure, so keeping the wound clean and dry is essential immediately following the surgery. Taking sitz baths and utilizing fiber supplements or stool softeners can help prevent straining during bowel movements that risks opening the wound. Any bleeding or uncontrolled flatulence or bowel movements that occur more than a week following the procedure should be reported to your physician.
Preventative Measures
Remember, once you’ve had an anal fissure, the more susceptible you are to their continued recurrence. Maintaining habits that prevent fissures in the first place is the best defense against them in the long run. Eating enough fiber, drinking the proper amount of fluids and finding an outlet for physical activity or exercise that you enjoy all contribute to improving digestion and preventing constipation.
Tips for Faster Healing
The question of how long do anal fissures last doesn’t have to be a mystery. Diet and exercise that helps promote healthy digestion will lessen the risk of constipation or difficult bowel movements that strain active fissures. Utilizing sitz baths and relaxation techniques to reduce anal sphincter tension will promote blood flow and speed up healing. Applying topical ointment or cream can help minimize symptoms and avoid further irritating the wound as it heals.
Take the Next Step to a Pain-Free Life
Faster healing is within reach when you equip yourself with the right tools. Just as with hemorrhoids, anal fissures can be tackled head on, and Doctor Butler’s is here to help. Whether it’s cleansing wipes or topical ointment, we’re ready to support caring for a fissure every step of the way.
H&F ointment
Excellent fast relief…excellent product
Verified ReviewerSources
- Jahnny B, Ashurst JV. Anal Fissures. [Updated 2022 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526063/
- Bužinskienė, D., Sabonytė-Balšaitienė, Ž., & Poškus, T. (2022). Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women’s Quality of Life and Treatment Methods. Frontiers in surgery, 9, 788823. https://doi.org/10.3389/fsurg.2022.788823
- Wald A. Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy. Gastroenterol Clin North Am. (2003) 32:309–22, vii. 10.1016/S0889-8553(02)00069-9
- Olive, J. L., DeVan, A. E., & McCully, K. K. (2002). The effects of aging and activity on muscle blood flow. Dynamic medicine : DM, 1, 2. https://doi.org/10.1186/1476-5918-1-2
- Assi, R., Hashim, P. W., Reddy, V. B., Einarsdottir, H., & Longo, W. E. (2014). Sexually transmitted infections of the anus and rectum. World journal of gastroenterology, 20(41), 15262–15268. https://doi.org/10.3748/wjg.v20.i41.15262
- Daniel R A Cox, Apoorva Rao, Eric Ee, Syphilis as an atypical cause of perianal fissure, Journal of Surgical Case Reports, Volume 2018, Issue 11, November 2018, rjy320, https://doi.org/10.1093/jscr/rjy320
- Hananel N, Gordon P H. Re-examination of clinical manifestations and response to therapy of fissure-in-ano. Dis Colon Rectum. 1997;40(2):229–233.
- Salem, A. E., Mohamed, E. A., Elghadban, H. M., & Abdelghani, G. M. (2018). Potential combination topical therapy of anal fissure: development, evaluation, and clinical study†. Drug delivery, 25(1), 1672–1682. https://doi.org/10.1080/10717544.2018.1507059
- Perrotti, P., Dominici, P., Grossi, E., Cerutti, R., & Antropoli, C. (2010). Topical nifedipine with lidocaine ointment versus active control for pain after hemorrhoidectomy: results of a multicentre, prospective, randomized, double-blind study. Canadian journal of surgery. Journal canadien de chirurgie, 53(1), 17–24.
- Sizar O, Genova R, Gupta M. Opioid-Induced Constipation. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493184/
- Radwan, M. M., Ramdan, K., Abu-Azab, I., & Abu-Zidan, F. M. (2007). Botulinum toxin treatment for anal fissure. African health sciences, 7(1), 14–17. https://doi.org/10.5555/afhs.2007.7.1.14
About Robert Cutler, D.O.
Dr. Robert Cutler has performed duties as a specialist in the field of Proctology over 30 years as a practicing physician. Over this time, he has had great success integrating patient care from both an efficiency standpoint and as a practical approach to holistic and preventative medicine.
Dr. Cutler also performs FDA approved Clinical Trials and has had formal research training in Human Subject Assurance Training, OHRP/NIH and Good Clinical Practice for Investigators, Quintiles. Dr. Cutler continues to work on creating more affordable solutions to help people who are affected by ano-rectal problems as well as various chronic or acute skin issues.
