What is an Anal Fissure?

An anal fissure is a small tear or cut in the lining of the anal canal. It causes sharp pain during and after bowel movements, bleeding (bright red blood on toilet paper) and spasm of the internal sphincter. Acute fissures heal with conservative treatment; chronic fissures (lasting more than 6 weeks) often require medical or surgical intervention.

Treatment Options

• Conservative (Acute Fissure) — high-fibre diet, increased fluid intake, sitz baths, topical anaesthetic cream. Most acute fissures heal within 4–6 weeks.
• Topical Therapy (Chronic Fissure) — Glyceryl trinitrate (GTN) 0.2% or Diltiazem 2% cream reduces internal sphincter spasm and improves blood flow. Healing in 50–70% of cases.
• Botulinum Toxin (Botox) Injection — injection into the internal sphincter relaxes spasm for 3–4 months; healing rate 60–80%. Office procedure under local anaesthesia.
• Lateral Internal Sphincterotomy (LIS) — gold standard surgical treatment for chronic fissure. A small cut is made in the lower part of the internal sphincter under local or spinal anaesthesia. Healing rate 90–95%. Day-care procedure.