Anal Fissure

Anal Fissures: Causes, Symptoms, and the Most Effective Treatments

Specialist Guide by Dr. Rodney Kratz, Colon & Rectal Surgeon

Anal fissures are one of the most common causes of sharp anal pain and bleeding, yet they are often mistaken for hemorrhoids. If you’re experiencing pain during bowel movements, burning afterward, or bright red blood on the tissue, you may have an anal fissure—a condition that is highly treatable when diagnosed correctly.

What Is an Anal Fissure?

An anal fissure is a small tear in the lining of the anus. It can occur after:

• Hard or large bowel movements
• Constipation
• Diarrhea
• Straining
• Childbirth
• Anal trauma

Although the tear is small, it triggers spasm of the internal anal sphincter, which reduces blood flow and prevents healing. This “spasm cycle” is the reason fissures cause such severe, sharp pain.

What Are the Symptoms of an Anal Fissure?

Key symptoms include:

• Knife-like pain with bowel movements
• Bright red bleeding
• Burning or throbbing pain that lasts minutes to hours
• Fear of having a bowel movement
• A visible or palpable skin tag (“sentinel pile”)

These symptoms are frequently confused with hemorrhoids, but the pain pattern is a major clue that the issue is a fissure.

Anal Fissure vs. Hemorrhoid: What’s the Difference?

Many patients google “hemorrhoid pain” when they’re actually experiencing a fissure. Here’s the distinction:

Anal fissure

• Sharp pain, bleeding, burning, sphincter spasm
• Pain level: usually severe

Hemorrhoids

• Pressure, bulging or prolapse, itching, bleeding
• Pain level: usually mild to moderate

A quick evaluation by a colon and rectal specialist can determine the correct diagnosis.

What Causes Anal Fissures Not to Heal?

Anal fissures become chronic when:

• Constipation continues
• The sphincter remains in spasm
• Scar tissue forms
• Blood flow is reduced
• Inflammation persists

Many chronic fissures won’t heal without targeted medical therapy or office-based procedures.

How Are Anal Fissures Treated?

At Precision Proctology, I use a stepwise, proven treatment protocol designed to break the spasm cycle and restore normal healing.

1. Non-Surgical Treatment

Best for acute fissures:

• Stool softeners
• Fiber optimization
• Hydration
• Sitz baths
• Gentle hygiene techniques

These promote healing by softening stool and reducing trauma.

2. Prescription Medications for Anal Fissures

Chronic fissures often require medical therapy, including:

• Topical calcium channel blockers
• Nitroglycerin ointments
• Compounded medications to relax the internal sphincter
• Pain-reducing topical agents

These medications increase blood flow and reduce sphincter tightness, speeding healing.

3. Botox Injection for Chronic Anal Fissures

Botulinum toxin (Botox) temporarily relaxes the sphincter and interrupts the spasm cycle. This is an excellent, non-surgical option for many patients and has high healing rates.

4. Surgical Treatment

Surgery is reserved for fissures that fail medical therapy or are severely chronic.

Lateral internal sphincterotomy (LIS) with fissurectomy

• The gold standard for chronic fissures
• High healing rates and long-term success
• Cutting a small portion of the internal sphincter
• Removal of scar tissue to promote healthy healing
• Combined procedures for patients with fissures plus hemorrhoids or skin tags

My surgical approach prioritizes pain relief and continence preservation.

How Long Does It Take an Anal Fissure to Heal?

• Acute fissures: often heal in 1–4 weeks
• Chronic fissures: may require prescription therapy or interventions
• After Botox: many heal within 6–12 weeks
• After LIS surgery: high success rates with rapid symptom improvement

Healing time varies based on severity, bowel habits, and underlying anatomy.

When Should You See a Specialist?

Seek medical evaluation if:

• You’ve had pain for more than 4–6 weeks
• You experience severe or worsening pain
• You’re unsure whether it’s a fissure or hemorrhoids
• There is persistent bright red bleeding
• You’ve already tried conservative care without improvement

Early treatment prevents fissures from becoming chronic and avoids unnecessary suffering.

Why Patients Choose Precision Proctology

• Board-certified colon and rectal surgeon with decades of experience
• Expertise in fissures, hemorrhoids, abscesses, and fistulas
• Private, discreet specialty practice
• Same-day treatment plans
• Precise diagnosis (no guessing or mislabeling hemorrhoids)
• Follow-up focused on full healing and long-term prevention

My goal is simple: help you heal quickly and reduce the chance of recurrence.

How to Prevent Anal Fissures From Returning

• Maintain soft, regular bowel movements
• Avoid excessive straining
• Stay hydrated
• Increase dietary fiber or take a supplement
• Treat constipation early
• Protect the area from trauma or irritation

Preventive strategy is always part of your treatment plan.

Schedule an Evaluation for Anal Fissure Treatment

If you’re suffering from sharp anal pain or bleeding, you don’t need to wait for it to “go away.” With the right specialist, fissures are highly treatable.

Precision Proctology
3216 NE 45th Pl, Suite 212
Seattle, WA 98105
Call or text: 425-515-0276