Anal fissure during pregnancy – can it be treated and what is safe?

Content author: physician. Joanna Szul, proctologist · Editorial work: Editorial team of Wyspa Medycyny Przyjaznej · Medical review: lek. Joanna Szul · Date of creation: 07.08.2026 · Date of review: 07.08.2026 · Updated: 07.08.2026

The article is of an educational nature and does not replace a proctological examination. During pregnancy, no medicine or preparation - even over the counter - should be used without consulting a doctor. Heavy bleeding, fever, severe increasing pain, as well as vaginal bleeding, abdominal pain, uterine contractions or amniotic fluid drainage require immediate contact with a doctor or a visit to the emergency room.

The most important information at a glance

• An anal fissure is a small tear in the mucous membrane of the anal canal - painful, but not dangerous in itself.
• Yes, it can be treated during pregnancy. The basis is conservative treatment, which is safe.
• The most important element of treatment is not the ointment, but the consistency of the stool.
• Constipation is easier during pregnancy - due to hormonal changes, uterine pressure, less activity and iron preparations.
• Iron preparations cannot be stopped on your own - the change is decided by the doctor supervising the pregnancy.
• No medicine or ointment, even over the counter, should be used during pregnancy without consultation.
• Bleeding during pregnancy should never be attributed to a fissure - it requires determining the source.
• Elective procedures are usually postponed until after childbirth, if the patient's condition allows it.
• A significant proportion of fissures heal after childbirth when the factors that caused them disappear.
• Pain that gets worse after each bowel movement and lasts for hours is typical - and a reason to seek treatment sooner rather than later.

Find out more about the specialist

Doctor. Joanna Szul is a proctologist at Wyspa Medycyny Przyjaznej in Gdańsk. He deals with the diagnosis and treatment of diseases of the anal area. Proctological problems during pregnancy and after childbirth require special caution in the selection of treatment - and at the same time, they are not a reason to leave the patient without help until delivery.

Meet the doctor. Joanna Szul Proctological consultation

What is an anal fissure

An anal fissure is a longitudinal tear in the mucous membrane lining the anal canal. It most often occurs when hard, compact stool passes through the canal - the mechanism is simple and mechanical, although the effects can be bothersome for weeks.

The key to understanding the whole problem is what happens next. Pain causes a reflex contraction of the sphincter. A contracted sphincter impairs blood supply to the area. A wound with poorer blood supply heals slower - and each subsequent bowel movement tears it apart again. This vicious circle is the reason why a fissure can persist for months, even though the wound is small.

The whole logic of treatment is to break this cycle in three places at once: softening the stool, reducing pain and relaxing the sphincter. During pregnancy, this logic remains the same - only the tools that can be used change.

Why pregnant?

Pregnancy creates almost a set of conditions conducive to the formation of a fissure. It is worth knowing them, because most of them can be influenced.

• Hormonal changes slow down the functioning of the intestines, which promotes constipation.
• The pressure of the growing uterus on the intestines and pelvic vessels hinders the passage and outflow of blood.
• Iron preparations, taken very often during pregnancy, cause constipation in many women.
• Less physical activity, especially in the third trimester or when recommended to exercise.
• Drinking less fluids - sometimes consciously limited due to frequent urination.
• Changing the rhythm of bowel movements and postponing them "for later".
• Childbirth - pressure and trauma to the perineum area may lead to the formation of a gap or deepen an existing one.

The point about iron requires a clear comment, because patients often solve the problem themselves. Iron preparations cannot be discontinued on their own. They are taken for a specific reason, and anemia in pregnancy has much more serious consequences than constipation. However, it is worth telling the doctor supervising the pregnancy about the problem - the dose, form of the preparation or method of administration can sometimes be modified.

Symptoms - how to recognize a fissure

The second line is the most characteristic. Pain that persists for a long time after defecation distinguishes a fissure from hemorrhoids, which are dominated by a feeling of fullness, itching and bleeding, and the pain tends to be less severe. This distinction is important because the treatment of both problems is different.

However, one caveat is indispensable: the diagnosis is not made on the basis of symptoms. Bleeding during pregnancy happens for many reasons and you should not assume that it is coming from the fissure. A medical evaluation is necessary.

When not to wait a day

The following situations require urgent contact with a doctor, and some of them require immediate reporting to the emergency room:

• heavy bleeding, blood filling the vagina or continuous bleeding,
• fever, chills, increasing redness of the anal area, palpable painful lump, discharge of pus,
• severe pain that does not go away between bowel movements,
• stopping urination or defecation,
• weakness, dizziness, rapid heartbeat, paleness,
• dark, tarry or mixed with stool blood,
• vaginal bleeding - a source other than the anus and always requiring urgent obstetric evaluation,
• abdominal pain, regular uterine contractions, drainage of amniotic fluid or decreased baby movements.

The last two points do not concern proctology, but they must be included here. A pregnant woman is not always able to determine where the bleeding comes from, and the consequences of a mistake are completely different. In case of any doubts, the first contact should be with the doctor supervising the pregnancy or the emergency room.

What is safe - the basis of treatment during pregnancy

The basis of treatment of the fissure - during and outside pregnancy - is not ointment, but stool. This sentence sounds trivial, but it is the most important sentence of this article. As long as hard stool passes through the healing wound, no local treatment will be effective.

The following actions are safe during pregnancy and are the first line of treatment:

• Adequate fluid intake throughout the day - without it, fiber makes things worse, not better.
• Dietary fiber — vegetables, fruits, whole grains, linseed; increased gradually, not overnight.
• Sitting sessions in lukewarm water - several minutes, especially after defecation; they relax the sphincter and bring relief.
• Failure to postpone a bowel movement - the longer the stool remains, the harder it is.
• Short time on the toilet - no phone, no reading, no prolonged sitting and pushing.
• Avoiding pushing - If it doesn't work, it's better to get up and try later.
• Gentle hygiene - washing with lukewarm water instead of intensive wiping with paper.
• Physical activity to the extent agreed with the doctor supervising the pregnancy.
• Foot rest when sitting on the toilet - changes the angle, facilitates bowel movements without pushing.

These actions do not sound impressive, but for a large number of patients they are enough - provided that they are used consistently and every day, and not only on days when it hurts. A wound in this area takes weeks, not days, to heal.

Medicines and preparations - there is one rule

During pregnancy, there is a rule to which we make no exceptions: a doctor decides about each medicine, ointment, suppository, herbal preparation and supplement. This also applies to products available without a prescription, advertised as natural or recommended by friends.

The reason is not formal. Some preparations commonly used in proctology have limitations during pregnancy, some herbs have an undesirable laxative effect, and some ointments contain ingredients that are not recommended for pregnant women. Therefore, the selection of local treatment, stool softeners and possible analgesic treatment is always individual - and takes into account both the trimester of pregnancy and subsequent breastfeeding.

What is worth mentioning during the visit so that the doctor can choose the treatment:

• what week of pregnancy it is,
• what preparations you take, including vitamins and iron,
• whether you plan to breastfeed,
• how long the symptoms last and what you have already tried to use,
• whether they occurred previous proctological problems, also in previous pregnancies,
• whether the pregnancy is progressing normally and whether there are any restrictive recommendations.

What about treatments?

The question is asked at almost every visit, so I answer directly: planned procedures are usually postponed until after childbirth. This is due to several reasons at the same time - caution regarding pregnancy, restrictions on anesthesia and drugs, but also a purely practical argument.

This practical argument is as follows: a significant part of the fissures formed during pregnancy heal after deliverywhen the factors that caused them disappear - uterine pressure, hormonal constipation, iron preparations. Performing the procedure on a problem that has a high chance of resolving itself would be excessive.

This does not mean that the patient is left alone with the pain. Conservative treatment is carried out throughout pregnancy, its effectiveness is monitored and modified if it does not work. The postponement is for the procedure, not the care.

The exception are urgent situations - an abscess around the anus, a hemorrhoidal clot with very severe symptoms or other conditions requiring quick intervention. Then the procedure is determined individually, in cooperation with the doctor supervising the pregnancy.

After childbirth

The postpartum period can be more difficult than patients expect. The first bowel movement after giving birth is a source of real fear, especially if there is a perineal wound, and the fear of it leads to postponement - and to constipation, which makes everything worse.

What is important during this period:

• Do not postpone the first bowel movement - the longer it is, the more difficult it is.
• Stay hydrated and fiber, especially when breastfeeding, which increases fluid needs.
• Continue sitz bathsif they provide relief and there are no contraindications due to the perineal wound.
• Report any complaints during the postpartum visit - this is a natural moment, not an embarrassing side topic.
• Do not use medications without consulting also while breastfeeding.

If the symptoms persist despite conservative treatment for several weeks after delivery, it is time to re-evaluate the proctological procedure and consider further treatment. A chronic fissure that does not heal despite proper treatment may require surgical treatment - however, the decision is made individually, after an examination.

It is also worth remembering that after giving birth, we assess not only the gap itself. If there are problems with holding gas or stool, it is advisable to evaluate the sphincters - because this is a completely different issue that requires different treatment.

The most common myths

• "There's nothing you can do about it during pregnancy." Not true. Conservative treatment is effective and safe.
• "It's definitely hemorrhoids." Not necessarily. Pain that persists for a long time after defecation suggests a fissure.
• "Bleeding during pregnancy is always a fissure." No. The source of the bleeding must be determined, and vaginal bleeding requires urgent obstetric evaluation.
• "Over-the-counter ointment is safe." Not always. During pregnancy, each preparation requires consultation.
• "Herbs are natural, so harmless." Some herbs have a laxative effect, which is undesirable during pregnancy.
• "You have to stop taking iron because it causes constipation." Not alone. The modification is decided by the doctor supervising the pregnancy.
• "Proctological examination during pregnancy is dangerous." The test itself does not pose a threat to pregnancy; they are performed gently and taking into account the patient's comfort.
• "It's better to wait until you give birth to visit." Conversely, the longer the crack lasts, the harder it is to heal.
• "After giving birth, it will go away by itself." Often yes, but not always - persistent symptoms require evaluation.

It hurts when you have a bowel movement and you don't know what to use?

Proctological problems during pregnancy can be treated safely. The earlier we start, the simpler the procedure is - and the less chance the problem will become chronic.

Proctology during pregnancy at the Island of Friendly Medicine in Gdańsk

Bow. At Wyspa Medycyny Przyjejnej, Joanna Szul consults patients with anal problems, including during pregnancy and postpartum. The visit includes an interview, a proctological examination tailored to the patient's situation and the establishment of a conservative treatment plan, taking into account the trimester of pregnancy and planned breastfeeding.

If the symptoms persist after delivery or require surgical treatment, we plan further treatment after the postpartum period. We also deal with treatment of hemorrhoids and other diseases of this area. The current scope of services, availability of dates and prices must be confirmed during registration.

Anal fissure - treatment Proctological consultation

What to ask during the visit?

• Is it really a crack or something else?
• What can I safely use during my trimester?
• Do any of the medications I take make it worse?
• What should I do with iron if it's constipating me?
• How long should I follow the recommended procedure before assessing the effect?
• Are sitz baths recommended in my case?
• Can ailments affect the course of childbirth?
• What will be safe when I start breastfeeding?
• How to prepare for the first bowel movement after giving birth?
• When should I go for a check-up?
• What should I worry about between visits?
• If it doesn't heal after delivery - what are the options?

FAQ - anal fissure during pregnancy

Can anal fissure be treated during pregnancy?

Yes. The basis is conservative treatment - softening the stool, adequate hydration, fiber, sitz baths and changing toilet habits. These actions are safe and are sufficient for many patients.

What is most important in treatment?

Stool consistency. As long as hard stool passes through the healing wound, local treatment will not be effective.

Can I use an over-the-counter ointment?

Not without consultation. During pregnancy, each preparation - including over-the-counter, herbal or supplement - is decided by a doctor, taking into account the trimester and planned breastfeeding.

Are you sure it's a fissure and not hemorrhoids?

Sharp pain that persists for a long time after defecation indicates a fissure, and the feeling of fullness, itching and bleeding indicate hemorrhoids. However, the diagnosis is made after examination, not on the basis of symptoms.

Is rectal bleeding during pregnancy dangerous?

Any bleeding requires determining the source and should not be assumed to be coming from a fissure. Vaginal bleeding is a completely different situation and requires urgent obstetric evaluation.

Is proctological examination during pregnancy safe?

The test itself does not pose a threat to pregnancy. They are performed gently, in a convenient position and taking into account the patient's comfort. The scope of the examination is adapted to the situation.

Are treatments performed during pregnancy?

Elective procedures are usually postponed until after childbirth, among other things, because a significant number of fissures heal spontaneously when the factors that caused them disappear. In urgent situations, the procedure is determined individually.

Should you stop taking iron if it causes constipation?

Not alone. Anemia during pregnancy has more serious consequences than constipation. However, it is worth reporting the problem to the doctor supervising the pregnancy - sometimes it is possible to modify the dose or form of the preparation.

Will the gap affect childbirth?

This is a question for the doctor supervising the pregnancy, because obstetric decisions belong to him. It is worth informing him about proctological problems before giving birth.

Will the fissure heal after giving birth?

In many women this happens when constipation and uterine pressure subside. If symptoms persist for several weeks after delivery despite treatment, repeated proctological evaluation is recommended.

I'm afraid of having my first bowel movement after giving birth - what should I do?

First of all, do not put it off, because putting it off leads to constipation and worsens the situation. Hydration, fiber and avoiding pushing are important, and if concerns are severe, discuss this at the postpartum visit.

When should I report urgently?

In case of heavy bleeding, fever with a painful lump or discharge of pus, severe pain between bowel movements, as well as bleeding from the genital tract, abdominal pain, uterine contractions or weakness of the baby's movements.

Sources

• Island of Friendly Medicine, anal fissure: https://www.wyspamedycynyPrzyjaznej.pl/pl/szczelina-odbytu
• Island of Friendly Medicine, proctological consultation: https://www.wyspamedycynyPrzyjaznej.pl/pl/konsultacja-proktologiczna-gdansk
• Wyspa Medycyny Przyjaznej, treatment of hemorrhoids: https://www.wyspamedycynyPrzyjaznej.pl/pl/leczenie-zylakow-odbytu-hemoroidow-gdansk
• NHS, Anal fissure: https://www.nhs.uk/conditions/anal-fissure/
• NHS, Constipation: https://www.nhs.uk/conditions/constipation/
• NHS, Constipation in pregnancy: https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/constipation/
• NHS, Piles (haemorrhoids) in pregnancy: https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/piles/
• NHS, Vaginal bleeding in pregnancy: https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/vaginal-bleeding/
• NHS, Medicines in pregnancy: https://www.nhs.uk/pregnancy/keeping-well/medicines/
• NHS, Your body after the birth: https://www.nhs.uk/pregnancy/labour-and-birth/after-the-birth/your-body/
• NHS, Bowel incontinence: https://www.nhs.uk/conditions/bowel-incontinence/
• American Society of Colon and Rectal Surgeons, Clinical Practice Guidelines: https://fascrs.org/healthcare-providers/education/clinical-practice-guidelines