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Anal Fissure: Symptoms and treatment
An anal fissure is a painful tear in the lining of the anal canal. It is a common condition that can cause significant discomfort and irritation. In this article, we will look at the causes, symptoms, and possible treatments for this frequent health problem.
Table of Contents:
An anal fissure (also called anal tear) is a tear in the mucosal lining of the anal canal (anoderm), which is particularly painful during bowel movements and when constipation occurs. Anal fissures can appear as both acute and chronic conditions. This guide provides medical information and tips, as well as an innovative method for self-treatment with FMS dilators.
In many cases, a (chronic) anal spasm or excessive tension of the anal sphincter is the root cause of discomfort. Relaxing the sphincter and performing gentle massages to strengthen the surrounding tissue are key measures to prevent chronic issues and avoid surgery.
Causes and Development
Anyone can experience an anal fissure, but they are particularly common between the ages of 30 and 40. Here is an overview of causes and contributing factors:
- Bowel Movements and Toilet Habits
- Bowel Diseases
- External Factors (often linked to sexual practices without preparation)
1. Bowel Movements and Toilet Habits
The most common cause of anal fissures or anal spasms is hard stool and constipation. The harder the stool, the more pressure is required during defecation. Proper nutrition is therefore crucial. Equally important is proper behavior during bowel movements: if you sit in the wrong position, passing stool can become more difficult, which may lead to an anal fissure. This condition is referred to as a primary anal fissure. Tips on correct toilet posture can be found in our hemorrhoid guide.
2. Bowel Diseases
People with chronic bowel conditions are more prone to anal spasms and thus to anal fissures or anal tears. Common conditions that may lead to these issues include hemorrhoids, persistent diarrhea, inflammation of the rectum (cryptitis), poor blood circulation, or excessive tension in the anal area. Individuals with chronic inflammatory conditions such as Crohn's disease or ulcerative colitis are also at higher risk. In these cases, doctors refer to a “secondary anal fissure.”
3. External Factors
Unprepared anal penetration, extreme sexual practices like fisting, or inserting unsuitable or overly large objects into the anus can cause painful spasms, mucosal injuries, and anal fissures. These injuries can also become chronic.
It is not the sexual practices themselves that are usually the problem, but rather a lack of caution or mindfulness when exploring physical boundaries. Especially under the influence of alcohol or drugs, medical assistance or a visit to the hospital is often required.
Diagnosis
The right specialist for anal pain or problems is a proctologist or gastroenterologist. A description of symptoms from the patient, combined with visual examination and a digital rectal exam by the doctor, is usually sufficient for diagnosis.
In about 90% of cases, the fissure appears at the 6 o'clock position (from the doctor’s perspective with the patient lying on their back – toward the tailbone) and extends lengthwise toward the center. Less frequently, it occurs at 12 o'clock (toward the perineum) or in other positions of the sphincter. Palpation (manual examination) often reveals thickening or a painful ulcer. Increased muscle tension (sphincter hypertonia), which can lead to anal spasms, is also common.
Diagnosis must rule out conditions like hemorrhoids or anal vein thrombosis. In some cases, especially after the acute phase, the doctor may perform a proctoscopy (rectal endoscopy) to exclude other diseases. If symptoms last up to three months, the fissure is considered “acute.” Beyond that, it is termed “chronic.” Chronic fissures often have scarred wound edges due to repeated spasms, hypertrophic anal papillae, swelling, and sometimes a skin tag called a "sentinel pile."
Symptoms of Anal Fissure
The first noticeable symptoms are sharp or burning pain during bowel movements, often accompanied by bright red bleeding. The discomfort can continue after using the toilet, and the anus may itch or feel moist. When these symptoms persist for several days, a vicious cycle often develops: fear of pain leads the patient to delay bowel movements, causing harder stool, which worsens the fissure and pain. This can trigger an anal spasm, which reduces blood flow, increases constipation, and slows healing.
Treatment of Anal Fissure and Anal Tear
For efficient and gentle treatment, we recommend FMS dilators. Learn exactly how FMS dilators work for anal fissures and how to use them.
A key part of treatment is to avoid constipation and ensure soft, smooth bowel movements. Some doctors prescribe laxative suppositories in combination with pain-relieving creams. Alternatively, a fiber-rich diet (whole grains, vegetables, legumes, fruits – especially prunes) and plenty of fluids can help. It is also important to chew food thoroughly. During bowel movements, avoid rushing or straining; take your time.
Proper hygiene is also important: after dry wiping, clean the area with water or a damp cloth. Avoid wet wipes as they often damage the skin’s protective flora (and are harmful to the environment). To keep the skin supple and promote healing, you can use a soothing ointment. These measures are similar to those recommended in our hemorrhoid treatment guide.
If symptoms persist for more than three months, a surgical procedure (fissurectomy) might be recommended. This involves removing the affected tissue around the fissure to create a fresh wound that typically heals well. However, surgery can often be avoided.
The most important step in treating anal fissures, anal tears, or anal spasms is to reduce constant anal sphincter tension by promoting relaxation.
Conventional medical treatment usually involves the following: in the acute phase, ointments are prescribed that you apply several times daily. These contain a local anesthetic and a muscle relaxant. Their purpose is to (1) reduce pain during bowel movements and thus avoid the urge to delay defecation, and (2) relax the sphincter muscle and reduce spasms. As an alternative to surgery, Botox injections can be used in chronic cases to relax or temporarily paralyze the sphincter muscle. This lowers tension, although it may cause temporary incontinence, which typically resolves as the Botox effect wears off.
Note: Ointments and Botox only relieve symptoms, not root causes. Lasting improvement requires active self-treatment, relaxation techniques, and lifestyle changes.
Relaxation of the Anal Sphincter with Dilators
Dilation of the anus with stretching tools, known as dilators, directly addresses the cause of the problem. This treatment can be performed independently, without a doctor’s supervision, and at your own pace.
However, traditional dilators have some drawbacks:
- The conical shape of standard dilators creates increasing pressure as they are inserted deeper, which can worsen fissures.
- Materials like silicone or plastic are not very smooth or gliding.
- The size increments of standard dilators are often too coarse. Treating anal fissures requires very precise size adjustments.
The Alternative: Therapy with FMS Dilators
Key differences from conventional dilators:
- Streamlined shape instead of wedge form – they slide gently into the body.
- Made of ultra-smooth borosilicate glass instead of silicone – significantly less friction.
- 27 sizes for precise customization to your needs.
These unique features ensure a very gentle yet highly effective application.
As a certified medical device, their effectiveness is proven. Borosilicate glass is 100% hygienic, durable, and sustainable, and it is much easier to clean compared to plastics. Despite the excellent gliding properties of the material, you should always use a high-quality lubricant.
FMS glass dilators are also suitable for the treatment of:
- Hemorrhoids
- Incontinence
- Vaginismus
- and for prostate massage.
Frequently Asked Questions
What is an anal fissure?
It is a tear in the mucosal lining of the anus, usually located at the 6 o'clock position (toward the tailbone).
What are typical symptoms of an anal fissure?
Sharp pain during and after bowel movements, along with bleeding that is visible on the stool or toilet paper. Fear of pain often leads patients to delay bowel movements, resulting in harder stool and worsening of the fissure—a vicious cycle.
What should I do if I have an anal fissure?
Ensure soft stools by drinking plenty of fluids and eating a fiber-rich diet. Maintain the correct sitting position on the toilet. Medications include numbing and muscle-relaxing creams, as well as Botox injections. As a self-therapy, gentle stretching (dilation) of the anus can be helpful.
What causes an anal fissure?
Common causes include delaying bowel movements, leading to hard stool that is then forced out in an unfavorable sitting position. Anal fissures can also result from chronic bowel diseases or as a side effect of chemotherapy. Other causes are careless sexual practices or extreme tension due to psychological trauma.
Is surgery necessary for an anal fissure?
Not necessarily. There are various medical, natural, and self-help methods for treating anal fissures. If the condition lasts longer than three months, it is classified as chronic, and surgery is usually recommended.
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