Anal Fissure: Causes, Treatments, and What Really Works

When you feel a sharp, burning pain during or after a bowel movement, it’s often not just constipation—it could be an anal fissure, a small tear in the lining of the anus that commonly results from passing hard stools. Also known as an anal裂伤, it’s more common than most people realize, especially in people with chronic constipation or after childbirth. This isn’t just discomfort—it can turn into a cycle of pain, fear of going to the bathroom, and worse constipation, making the problem even worse.

An anal fissure, a small tear in the lining of the anus that commonly results from passing hard stools usually heals on its own in a few weeks with simple changes: more fiber, more water, and avoiding straining. But if it sticks around past six weeks, it’s considered chronic—and that’s when you need to look at other options. Topical nitroglycerin or calcium channel blockers like diltiazem can relax the sphincter muscle and boost blood flow to the area, helping the tear close. Botox injections are another non-surgical option that temporarily paralyzes the muscle to reduce spasm and pain. Surgery, like a lateral internal sphincterotomy, is only needed if these fail, and even then, it’s highly effective.

What you eat matters more than you think. A diet low in fiber leads to hard stools, which is the #1 cause. But even if you’re eating veggies, dehydration or ignoring the urge to go can still trigger it. Some people notice it after diarrhea too—repeated wiping or inflammation can tear the tissue. Pregnancy and childbirth are major risk factors because of pressure on the pelvic floor. And while it’s not caused by hemorrhoids, they often show up together, making it harder to tell what’s really hurting.

There’s no magic pill, but there are proven fixes. Warm sitz baths for 10–15 minutes after each bowel movement help relax the muscle and soothe the area. Over-the-counter creams with lidocaine give temporary relief, but they don’t heal the tear. Stool softeners like docusate sodium are safer long-term than stimulant laxatives, which can irritate the area. If you’re on medications that cause constipation—like opioids or certain antidepressants—talk to your doctor about alternatives.

What’s missing from most advice is the mental side. Fear of pain makes people hold it in, which makes stools harder, which makes the fissure worse. It’s a loop that’s hard to break. The key is breaking that fear with consistent, gentle habits—not waiting for the pain to go away before acting. Start with fiber supplements if you’re not getting enough from food. Try psyllium husk—it’s gentle and works well with plenty of water. Keep a log of your bowel habits and pain levels. You might spot patterns: maybe it flares after coffee, or after a long car ride, or when you’re stressed.

You’ll find posts here that cover related issues—like how to manage chronic diarrhea that irritates the area, or how certain medications like laxatives or opioids affect bowel function. There are guides on using medication logs to track triggers, and how to avoid drug interactions that worsen constipation. You’ll also see advice on non-surgical treatments that work, and what to expect if things don’t improve. This isn’t about quick fixes. It’s about understanding the body’s signals and making smart, lasting changes.