Health Information: Anal fissure


An anal fissure is a tear or an ulcer in the lining of the anal canal.


Anal fissures can become chronic (permanent) where patients experience some symptom-free phases (remissions) and worsening of their condition.


- Drink at least 8 glasses of water daily (as inadequate water intake can encourage dry, hard stools to form).
- Eat high-fibre foods to promote regular bowel actions.
- Don't strain during defecation.
- Avoid anal intercourse


Anal fissures can occur when the walls of the anal canal are stretched by large, hard stools or by a foreign object (e.g. during anal intercourse).

The risks of developing an anal fissure are increased by certain medical conditions, including constipation, multiple pregnancies, leukaemia, Crohn's disease and chronic use of laxatives.


- Pain and bleeding with bowel movements.
- The pain usually occurs with or shortly after defecation and lasts for several hours before subsiding until the next bowel movement.
- There may be streaks of blood on the toilet paper or underwear.

Treatment Options

As with all medical conditions, consult your doctor for the diagnosis and treatment of anal fissure. The diagnosis of anal fissure is made by a physical examination and your doctor may need to examine the lining of the anal canal using a special instrument called an anoscope or sigmoidoscope

Anal fissures are fairly common and usually heal without treatment or with nonsurgical treatments. Your Doctor may recommend lifestyle and dietary changes e.g increasing fibre and water intake etc. Your Doctor may recommend or prescribe a steroidal cream to relieve inflammation and ease discomfort. An ointment containing nitroglycerine may be prescribed for you. When applied to the anus this helps to widen blood vessels and increase blood flow to the tear, promoting healing.

- Most people recover in 4 - 6 weeks after receiving the appropriate medical treatment. If the anal fissure does not heal, surgery may be necessary to control the muscle spasms that prevent the anal fissure from healing.
- Medications such as paracetamol can help relieve the painful symptoms of anal fissure. DO NOT take a product that contains aspirin or ibuprofen as these can prevent blood from clotting and increase blood loss from the anal fissure. Aspirin should generally not be given to children under 16 years of age unless specified by a doctor. Aspirin should especially be avoided in children aged 12 to 15 if they are feverish.

Pharmacist's Advice

Ask your Pharmacist for advice
1) Keep bowel movements regular. Ask your Pharmacist about some fibre products (e.g. psyllium) and slippery elm to help.
2) Stool softeners can moisten the stools to minimise the risks of aggravating the anal fissure during defecation. Ask your Pharmacist to recommend a suitable product.
3) Drink plenty of water to prevent the stools from becoming dry and hard. Consider using a water filter jug to provide clean, filtered drinking water.
4) Warm compresses and baths can relieve the pain caused by anal fissures. Ask your Pharmacist about a special sitz bath that enables you to bath the buttock area without having to immerse the rest of your body.

Supplements And Herbs

- Slippery elm and acidophilus feed the good bacteria in the bowel, which helps aid in healthy bowel movements.
- Digestive enzymes (such as papain, bromelain, hydrochloric acid tablets and pepsin) may increase digestion and elimination of wastes. Digestive enzymes are available in formulas in health food stores.
- Aloe vera juice is a laxative and decreases inflammation of the bowel wall.
- Magnesium may help cramps and griping associated with constipation. Magnesium may help relax the bowel wall and promote movement.


- Your diet should be high in fibre. Good sources of dietary fibre include bran, wholemeal and wholegrain foods (e.g. brown rice, wholemeal bread, oats); fresh, raw fruits and vegetables such as apples and pears; and legumes (baked beans, 3-bean mix, etc).
- Psyllium is a water-soluble fibre which may increase the bulk of the bowel. Psyllium fibre should always be taken with a large glass of water.
- For regulating bowel movements, apple cider vinegar taken daily e.g. 2 teaspoonfuls in water on waking can be helpful. Linseed meal is a valuable source of fibre and is also very tasty over cereal. Your health shop has a wide range of wholegrain breakfast cereals to choose from.
- Minimise caffeine intake (cola, tea, coffee, chocolate) as it can cause dehydration.
- Having a teaspoon of apple cider vinegar diluted in a glass of water 30 minutes before main meals aids in the thorough digestion of foods in the stomach by activating the secretion of hydrochloric acid into the bowel.
- See the constipation diet topic on the Healthpoint for further information.

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