Anal Fissures: Self-Care and Prevention

An anal fissure is a small tear or crack in the thin, moist tissue lining the anus (where stool leaves the body). It often causes sharp, shooting pain during or after a bowel movement. Bleeding is also common. You might find bright red blood on toilet paper after wiping or in the toilet bowl. 

Passing large or hard stools, straining during bowel movements, constipation, and frequent diarrhea can damage the fragile tissues lining the anus and cause an anal fissure. Symptoms can develop suddenly or gradually, and anal fissures can be acute (short-term) or chronic, lasting eight weeks or more. Attempting to delay or avoid bowel movements to prevent pain can lead to or worsen constipation, causing more discomfort and delaying healing.

Most anal fissures do not require treatment and heal over time. Self-care measures like sitz baths and a fiber-rich diet can help relieve symptoms and promote healing. 

With an anal fissure, injury to the tissue causes swelling, putting added pressure on the anal sphincter muscle. The increased pressure causes the muscle to spasm, causing more pain. Research shows that gentle massage relaxes the anal sphincter muscle, increases blood flow to the area, and reduces spasms, helping reduce pain and promote healing.

To perform self-massage on your anal sphincter muscle, apply a small amount of lubricant (e.g., Vaseline or a lubricant your healthcare provider recommends) to a gloved or clean index finger. Gently insert the finger into your anus and rub in a circular motion for approximately 10 minutes daily.

Sitz baths are warm water baths that can help soothe the anal area by relaxing the anal sphincter muscle, reducing pain and spasms. Fill a sitz bath basin or bathtub with enough warm water (comfortably warm, not hot) to cover your hips and buttocks. You can add Epsom salt or baking soda to the water for additional soothing, though this is optional.

Sit in the bath for 10-15 minutes, 2-3 times daily. If you experience pain after a bowel movement, a sitz bath can help relieve some pain. The warm water increases blood flow to the anal area, promoting healing and reducing pain and inflammation. After a sitz bath, gently pat the area dry with a soft towel to prevent irritation. 

Applying topical treatments, including medicated creams and ointments, directly to the fissure can help relieve anal fissure symptoms and promote healing. Over-the-counter (OTC) topical treatments can help relieve pain and soothe and protect the anus from irritation. Options include: 

• Lidocaine: This anesthetic numbs the area, providing temporary pain relief for anal fissures. Topical OTC creams that contain lidocaine include Anecream, Gold Bond Medicated Pain-Itch, and Rectasoothe. 
• Petroleum jelly: Vaseline (petroleum jelly) helps protect the anal area from irritation and keeps the tissues moist to promote healing. 
• Zinc oxide: Creams containing zinc oxide create a protective barrier on the anus and soothe discomfort. OTC products containing zinc oxide suitable for use for anal fissures include Boudreaux Butt Paste, Desitin Ointment, and Perishield.
• Hydrocortisone: Creams and ointments containing 1% hydrocortisone, such as Anusol HC, Pandel, and Protocort Cream, can help relieve anal fissure pain, inflammation, and itch.

When using topical treatments, follow the application instructions provided by your healthcare provider or the product packaging. Discontinue use and talk to a healthcare provider if you experience adverse reactions, such as burning, itching, or a rash (bumps on the anal area).

Dietary changes can help support the healing process of an anal fissure by promoting smoother bowel movements and reducing strain on the anus. You can minimize discomfort by making a few simple dietary changes, including: 

• Hydration: Drink plenty of fluids throughout the day to keep stools soft and easier to pass. Drink 8-12 cups of non-alcoholic fluids daily, including water, milk, and juices, to stay hydrated and support healthy digestion. 
• Fiber: Increase your dietary fiber intake by consuming more fruits, vegetables, whole grains, and legumes. Fiber adds bulk to stools, making them softer and easier to pass, reducing straining and promoting bowel regularity. Aim for 25-35 grams (g) of fiber daily. Fiber supplements, such as Metamucil (psyllium), are another option.
• Stool softeners: OTC stool softeners, such as Correctol 50 Plus (docusate, sennosides) and Ex-Lax Gentle Strength (docusate, sennosides), can soften stools, making them easier to pass and reducing discomfort. Stool softeners come in capsule, liquid, and tablet forms. Follow the instructions on the label to determine the appropriate dosage and frequency. 

Incorporating healthy habits into your daily routine that ensure regular, strain-free bowel movements can help prevent anal fissures. These include the following: 

• Avoid straining: Don’t strain during bowel movements. If you have difficulty passing stool, stay on the toilet for no longer than 10 minutes and try again later. Consider using a foot or squat stool to help achieve a more natural position for easier elimination. 
• Fiber-rich diet: Eat plenty of fruits, vegetables, legumes, and whole grains to ensure a fiber-rich diet and help prevent constipation and hard stools. 
• Exercise regularly: Moderate physical activity at least 3-4 times weekly helps prevent constipation.
• Listen to your body: If you feel the urge to have a bowel movement, don’t delay or hold it in. 
• Hygiene: Keep your anal area clean and dry. After bowel movements, gently clean the area with water (e.g., bidet), toilet paper, or wipes and pat dry. Avoid using hard soaps or wipes containing chemicals that can irritate the skin. 

While most anal fissures heal on their own with self-care measures, it’s important to see a healthcare provider if you experience any of the following:

• Severe pain: Pain persists for more than 1-2 hours after a bowel movement.
• Persistent discomfort: Pain and bleeding persist for longer than a week despite self-care measures.
• Bowel changes: This includes constipation or diarrhea.
• Rectal bleeding: While some bright red blood is common with anal fissures, see a healthcare provider for heavy or persistent bleeding or bloody stools (blood in the stool) 
• Fever: A fever alongside anal fissure symptoms can be a sign of an anal infection.
• Incontinence: Loss of stool control, such as leaking stool, can be a sign of a more serious underlying condition. 
• Rectal discharge: Anorectal infection (abscess) can cause pus to leak from the rectum.

Anal fissures are small tears or cracks in the lining of the anus that cause pain and bleeding during and after bowel movements. Self-care measures, such as anal massage, sitz baths, topical treatments, and diet modifications, can relieve symptoms and promote healing.

You can lower your risk of anal fissures by adopting lifestyle habits that support healthy digestion, including eating plenty of fiber-rich foods, staying well-hydrated, and getting regular exercise.

See a healthcare provider if you continue to experience pain and bleeding during bowel movements despite at-home treatments and self-care measures or if you experience anal fissure symptoms along with other symptoms, such as fever, incontinence, or rectal discharge.