Medical content by Elias Tsiolis, Director Surgeon · Last updated: 11 May 2026
An anal fissure is a small but very painful tear in the skin or lining of the anal canal. Although in most cases it is a small lesion, it can cause severe pain, bleeding and discomfort when passing stool, significantly affecting quality of life. It is a condition that should not be neglected, because if it becomes chronic it can lead to sphincter spasm and a serious worsening of symptoms with a major impact on everyday life.
Everything You Need to Know About Anal Fissures
A fissure is a long, narrow wound in the wall of the anus. At first it is acute, but over time, if it does not heal, it can become chronic, forming an enlarged anal papilla on the inside.
Causes and Risk Factors
A fissure forms when the wall of the anus is injured and does not heal properly. The most common factors are:
- Chronic constipation
- Hard or large stools
- Prolonged straining during bowel movements
- Persistent diarrhea
- Childbirth (in women)
- Injuries to the area
- Increased sphincter tone
Symptoms
- Sharp, burning pain during bowel movements (like being “cut with a razor”)
- Bleeding (a small amount of bright red blood on the paper or in the toilet)
- Itching, irritation or moisture in the area
- Sphincter spasm, which increases the pain and makes bowel movements even more difficult
- In chronic cases, a skin tag on the outside and/or an enlarged anal papilla on the inside
Diagnosis
Diagnosis is made by clinical examination and proctoscopy by an experienced surgeon, because of the considerable pain in the area.
Treatment
Treatment aims both to heal the wound and to relieve pain and relax the sphincter.
Conservative Treatment
- For acute fissures:
- A diet rich in fiber & fluids
- Local anesthetic & healing ointments
- Avoiding constipation (mild laxatives)
- Drug treatment
- Glyceryl trinitrate or diltiazem (as a cream) to relax the sphincter
- Botox (botulinum toxin): a minimally invasive solution that temporarily relaxes the sphincter and allows healing
- Success rate >90%, without surgery.
Surgical Treatment
In chronic or resistant cases:
- Lateral internal sphincterotomy:
- A small cut in the internal sphincter that reduces the spasm and allows healing.
- Often combined with excision of the inflamed papilla and refreshing of the wound.
Recovery is quick, pain is minimal and the result is permanent.
Aftercare
- A gentle diet with fiber
- Good hygiene of the area
- Avoiding constipation or straining
- No strenuous physical activity for 7–10 days
Healing is complete in 2–3 weeks.
Frequently Asked Questions
Is an anal fissure dangerous?
No, but it causes severe pain, and if left untreated it can become chronic and harder to manage.
Can it be cured without surgery?
Yes, most acute fissures heal with conservative treatment or Botox. Surgery is only needed when other methods fail.
Is Botox treatment painful?
No, it is done under local anesthesia, in a few minutes, without a hospital stay.
Is the operation painful?
Lateral sphincterotomy is a painless and quick operation with minimal post-operative pain.
Can I go back to work straight away?
Yes, you can usually return to light work the next day.
Is there a risk of incontinence after surgery?
No, as long as the operation is performed by an experienced surgeon at Athens Surgery, which applies to all anal procedures.
What should I watch in my diet?
- Daily intake of fiber
- Plenty of fluids
- Avoiding spicy food, alcohol and coffee during flare-ups
When should I see a doctor?
If the pain is severe, lasts more than a few days or there is bleeding after every bowel movement.
Can it come back?
Rarely, if constipation returns or the instructions are not followed.
Is it related to cancer or other conditions?
No, a fissure is a benign condition. However, in some cases further investigation may be needed.