Anal Fissure — How Long Does It Take to Heal, and What Helps?

Medical author: Kamil Smok, MD, surgeon dealing with proctology - to be approved before publication · Editorial preparation: Wyspa Medycyny Przyjaznej editorial team · Medical review: Kamil Smok, MD - to be confirmed before publication · Created: 10.07.2026 · Review date: to be completed after approval · Updated: 10.07.2026

This article is educational and does not replace a proctology consultation. Rectal bleeding, severe pain, purulent discharge, fever, an enlarging lump near the anus, heavy bleeding, weight loss, anemia or a change in bowel habits require medical diagnostics.

Key information in brief

• An anal fissure is a tear in the delicate skin of the anal canal, usually causing sharp pain during bowel movement and burning afterward.
• Typical symptoms include pain "like being cut with glass", burning, anal spasm, bright red blood on toilet paper or stool, and fear of the next bowel movement.
• A fresh fissure may heal within a few weeks, especially if stool consistency is improved quickly and straining is limited.
• The longer symptoms last, the greater the risk that the fissure becomes chronic and requires specialist treatment.
• The most important part of healing is breaking the vicious circle: hard stool or diarrhea -> tear -> pain -> sphincter spasm -> poorer blood supply -> slower healing.
• Soft, regular stool helps most: fiber, fluids, constipation treatment, avoiding straining and calm toilet habits.
• Warm sitz baths or baths after bowel movement may reduce pain and sphincter tension.
• Topical medicines are selected by the doctor. They may relieve pain, relax the sphincter or support healing.
• Not every fissure requires botulinum toxin. Botox is considered in selected patients, especially with chronic fissure, strong sphincter spasm or ineffective conservative treatment.
• Rectal bleeding should not automatically be assumed to be a fissure or hemorrhoids. Diagnosis is needed first.

Learn more about the specialist

Kamil Smok, MD is a surgeon dealing with proctology at Wyspa Medycyny Przyjaznej in Gdansk. He diagnoses and treats diseases of the anus, anal canal and perianal area, including anal fissure, hemorrhoidal disease, fistulas, perianal abscesses and pilonidal cyst. In proctology work, he places particular importance on a calm atmosphere, discretion, tact and clearly explaining every stage of diagnostics to the patient.

Meet Kamil Smok, MD

Does this topic make sense for SEO, AI and Google Search?

Yes. Patients very often search for answers to questions such as: "how long does an anal fissure take to heal", "what helps an anal fissure", "anal fissure pain after bowel movement", "anal fissure blood", "how long does an anal fissure hurt", "will an anal fissure heal on its own", "ointment for anal fissure", "Botox for anal fissure", "anal fissure or hemorrhoids", and "proctologist anal fissure Gdansk". This is an educational blog with high health intent, which should guide the patient toward diagnostics, but should not replace the service page about treating fissure with botulinum toxin.

That is why the text answers patients' most common questions: how long healing takes, what really helps, why symptoms return, when a proctologist is needed and when specialist treatment is considered. Details of botulinum toxin treatment, qualification, price and booking should remain on the service page.

What is an anal fissure?

An anal fissure is a tear or ulceration of the anoderm, the very delicate skin in the anal canal. It most often forms as a result of mechanical injury during bowel movement: hard stool, strong straining, constipation or, conversely, frequent loose stools and irritation of the anal area.

The problem often begins with one painful bowel movement. Later, the patient becomes afraid of the next toilet visit, holds stool back, the stool becomes harder, and the next bowel movement damages the wound again. This creates a vicious circle that makes healing difficult.

A fissure may be fresh, meaning short-lasting and likely to heal with conservative treatment, or chronic - when it persists longer, recurs and is accompanied by persistent sphincter spasm, thickened wound edges or a sentinel skin tag.

What are the symptoms of an anal fissure?

Symptoms of an anal fissure are often very characteristic, although they are not enough for self-diagnosis. Similar symptoms may be caused by hemorrhoids, a thrombosed external hemorrhoid, abscess, fistula, inflammation, inflammatory bowel disease or other anal diseases.

Typical symptoms of an anal fissure include:

• sharp, stabbing pain during bowel movement, often described as "being cut with glass",
• burning or throbbing pain after bowel movement, lasting from several minutes to several hours,
• bright red blood on toilet paper, on the surface of stool or in the toilet,
• a feeling of spasm, tension or "closure" of the anus,
• fear of passing stool,
• constipation worsening the problem,
• sometimes itching, moisture or irritation around the anus,
• in chronic fissure: recurrent symptoms, thickening of the wound edge or a skin fold near the anus.

If purulent discharge, fever, an enlarging lump, severe throbbing pain not related only to bowel movement or general symptoms appear, a perianal abscess or another condition requiring rapid treatment must be ruled out urgently.

How long does an anal fissure take to heal?

A fresh anal fissure may heal within a few weeks, especially if the main cause is quickly removed: hard stool, straining, constipation, diarrhea or irritation of the anal area. In many patients, pain improves earlier than the wound heals completely, so recommendations should not be stopped immediately after the first improvement.

In practice, it can be viewed in three stages:

It is concerning if symptoms worsen after a week of self-care or there is no improvement at all. Consultation is even more important when the fissure returns with every harder stool or the patient has been functioning for weeks with pain after bowel movements.

Why does the fissure not want to heal?

An anal fissure often does not heal because the wound is located in an area constantly irritated by stool and sphincter tension. Every painful bowel movement may reopen the tear. Pain causes a reflex spasm of the internal sphincter, and the spasm worsens blood supply around the wound. Poorer blood supply means slower healing.

The most common causes of delayed healing are:

• hard stool,
• a habit of strong straining,
• holding stool because of pain,
• recurrent constipation,
• frequent diarrhea or anal irritation,
• overly aggressive hygiene and skin irritation,
• persistent sphincter spasm,
• abnormal pelvic floor tension,
• chronic inflammation,
• inflammatory bowel diseases, e.g. Crohn's disease,
• incorrect treatment "blindly", e.g. only hemorrhoid preparations without diagnosis.

That is why treating a fissure is not only about applying ointment to the wound. Healing conditions must be improved at the same time: stool, sphincter tension, pain, toilet habits and possible coexisting diseases.

What helps with an anal fissure?

The most important thing is softening the stool and reducing injury during bowel movement. If the stool is still hard and the patient still strains strongly, even the best ointment may not be enough. Treatment should be consistent for the recommended time, not only until the first day of improvement.

Healing may be supported by:

• stool regulation - so that the stool is soft but not diarrheal,
• fiber - from diet or preparations recommended by the doctor, introduced gradually,
• adequate fluids - especially when increasing fiber,
• constipation treatment - if the patient has hard stools, straining or infrequent bowel movements,
• diarrhea treatment - if frequent stools irritate the wound,
• avoiding straining and long sitting on the toilet,
• warm sitz baths or baths after bowel movement if they bring relief,
• gentle hygiene without aggressive rubbing or irritating cosmetics,
• topical medicines selected by the doctor,
• treatment of sphincter tension - topical or procedural in selected patients,
• pelvic floor physiotherapy in patients with abnormal tension, difficulty relaxing or habitual straining.

What should stool be like for a fissure to heal?

With an anal fissure, patients often focus on ointment, while stool is often the most important factor. Ideally it should be soft, formed, easy to pass and not require straining. Stool that is too hard tears the wound again, while diarrhea chemically and mechanically irritates the anal area.

In practice, it is worth avoiding two extremes:

• hard, compacted stool, which causes stretching and tearing of the wound,
• frequent loose stools, which increase burning, moisture and irritation.

If the patient has long-term constipation, irregular bowel movements, irritable bowel syndrome, diarrhea or uses medicines affecting stool, fissure treatment should include this element as well. The wound will not heal well if it is irritated every day.

Sitz baths - do they really help?

A warm bath or sitz bath after bowel movement may reduce pain, burning and sphincter tension. It does not "seal" the fissure by itself, but it may improve comfort and break the reflex spasm after a painful stool. For some patients, it is a very simple but important part of treatment.

It is important not to use very hot water, irritating additives, perfumed liquids or strong rubbing. After washing, the anal area should be gently dried without friction. Excessive hygiene, frequent washing with aggressive agents and moisture may worsen irritation.

Ointment for anal fissure - why do not all ointments work the same?

Patients often ask about the "best ointment for a fissure". The problem is that ointments have different goals. Some relieve pain, others reduce inflammation, while others are intended to relax the internal sphincter, improve blood supply and create conditions for healing. A preparation used "for hemorrhoids" does not always treat the cause of the fissure.

In a chronic fissure, the doctor may consider topical treatment affecting sphincter tension. Such preparations require qualification, discussion of how to use them and possible adverse effects, e.g. headache with some medicines. Do not independently mix many preparations or use medicines prescribed to someone else.

If after a few days of self-treatment the pain increases, bleeding persists or the patient begins to fear bowel movements, it is worth consulting the problem instead of buying more ointments without a diagnosis.

Botulinum toxin for anal fissure - when is it considered?

Not every anal fissure requires botulinum toxin. In many patients, the first step is conservative treatment: stool regulation, treating constipation or diarrhea, changing toilet habits, sitz baths and topical medicines. Botulinum toxin is considered in selected patients, especially when the fissure is chronic, there is strong sphincter spasm, pain is persistent or conservative treatment does not bring sufficient improvement.

The mechanism of action is temporary reduction of sphincter tension. This may improve blood supply around the fissure and conditions for healing. However, it is not a "procedure for everyone" and does not guarantee cure. It requires examination, qualification and discussion of possible benefits and limitations.

Details of the procedure, qualification, price, contraindications and post-procedure recommendations should remain on the service page concerning treatment of anal fissure with botulinum toxin.

Can an anal fissure recur?

Yes. A fissure may recur if the factors that caused it are not removed. Most often these include constipation, hard stool, strong straining, diarrhea, abnormal sphincter tension, holding stool or the habit of sitting on the toilet for a long time.

Recurrence does not mean the patient "treated it badly". It means that what makes healing difficult must be assessed again. Sometimes improving stool and returning to recommendations is enough, but recurrences require proctological diagnostics to rule out another cause of pain or bleeding.

Particular attention should be paid to atypical fissures: lateral, multiple, very difficult to heal, with purulent discharge, with suspicion of inflammatory bowel disease or infection. Such situations require broader assessment.

Anal fissure or hemorrhoids?

Anal fissure and hemorrhoids may both cause bright red blood during bowel movement, so patients often confuse these problems. The difference is that a fissure typically causes severe, sharp pain during passing stool and burning afterward. Hemorrhoids more often cause bleeding, itching, a feeling of a lump or prolapse, but they do not always cause such sharp pain.

However, diagnosis should not be based only on symptoms. Anal pain and bleeding may also result from a thrombosed external hemorrhoid, abscess, fistula, inflammation, polyp, inflammatory bowel disease or other diseases of the anus and rectum.

Therefore, diagnosis is needed before treatment. Otherwise, the patient may treat "hemorrhoids" for weeks while the main problem is a fissure, or the other way around.

When is anoscopy needed?

Anoscopy allows the doctor to view the anal canal and the final part of the rectum. It is helpful in diagnosing bleeding, pain, hemorrhoids, fissure, anal canal polyps and other proctological lesions. A full examination does not always have to be performed immediately, especially if the patient has very severe pain and sphincter spasm.

A good diagnostic plan should take patient comfort into account. The doctor may first talk with the patient, inspect the anal area, perform an examination within the patient's tolerance and plan a fuller assessment after pain decreases. The most important thing is not to treat blindly for many weeks.

When does an anal fissure require urgent consultation?

An anal fissure itself is usually not an emergency, but not every anal pain is a fissure. Some symptoms should not be waited out or treated at home.

More urgent assessment is required for:

• severe increasing anal pain, especially throbbing and independent of bowel movement,
• fever, chills or feeling unwell,
• purulent discharge from the anal area,
• a rapidly enlarging lump near the anus,
• heavy bleeding, clots or weakness,
• black stool or suspicion of bleeding from a higher part of the digestive tract,
• recurrent bleeding despite treatment,
• unintentional weight loss, anemia or chronic weakness,
• a new change in bowel habits, night diarrhea or stools with a large amount of mucus,
• suspicion of Crohn's disease or ulcerative colitis,
• an atypical, lateral, multiple or non-healing anal wound,
• pain after trauma, anal intercourse or suspected sexually transmitted infection.

What should you not do with an anal fissure?

With an anal fissure it is easy to fall into mistaken actions that worsen the problem. Do not:

• strain strongly to pass stool,
• sit on the toilet for a long time with a phone,
• hold stool because of fear of pain,
• use many random ointments at the same time,
• treat "hemorrhoids" for weeks without diagnosis,
• wash and rub the anal area aggressively,
• use irritating wipes, perfumed cosmetics or alcohol,
• perform enemas without recommendations,
• ignore bleeding just because "it is probably a fissure",
• postpone visits if pain lasts, returns or makes daily functioning difficult.

The biggest mistake is waiting for chronic pain to pass on its own, even though every stool reopens the wound. The longer the problem lasts, the more difficult treatment may become.

The most common myths about anal fissure

• "It is definitely hemorrhoids." Not always. Sharp pain during bowel movement and burning after stool more often suggest a fissure, but examination is needed.
• "A fissure always heals on its own." A fresh one may heal, but a chronic fissure often requires specialist treatment.
• "Ointment is enough." Not always. Without soft stool and limiting straining, ointment may not be enough.
• "If the pain eased a little, treatment can be stopped." Not always. Pain may decrease before the wound heals completely.
• "Botox is for everyone." No. Botulinum toxin is considered in selected patients after qualification.
• "Blood with stool is always from a fissure." No. Rectal bleeding may have many causes and requires diagnostics.
• "You should avoid eating to go to the toilet less often." No. This may worsen constipation and aggravate the fissure.
• "The stronger the hygiene, the better." Not always. Excessive washing and rubbing may irritate the anal area.
• "Anal pain should be waited out because of embarrassment." No. A proctologist deals with such problems every day, and delaying may make the disease persistent.

Pain during bowel movement, burning and bright red blood?

Do not immediately assume it is hemorrhoids. An anal fissure often responds well to treatment, but first the diagnosis must be confirmed and the vicious circle of pain, spasm and constipation must be broken.

Diagnosis and treatment of anal fissure at Wyspa Medycyny Przyjaznej

At Wyspa Medycyny Przyjaznej in Gdansk, Kamil Smok, MD consults patients with pain during bowel movement, burning, rectal bleeding, suspected anal fissure, hemorrhoids, thrombosed external hemorrhoid, abscess, fistula and other diseases of the anus and perianal area.

During the consultation, the doctor assesses symptoms, duration of complaints, stool characteristics, toilet habits, previous treatment and possible causes of delayed healing. The scope of examination is adjusted to the patient's tolerance, especially when pain and anal spasm are very strong.

In some patients, conservative treatment and follow-up are enough. Others need topical medicines, constipation treatment, pelvic floor physiotherapy or qualification for botulinum toxin treatment. The goal is not to "wait out" the pain, but to identify the cause and match treatment to the type of fissure.

Learn more about Kamil Smok, MD Anal fissure treatment Anoscopy

What should you ask the proctologist about an anal fissure?

• Do my symptoms fit an anal fissure?
• Is it a fresh or chronic fissure?
• Does the bleeding require additional diagnostics?
• Is anoscopy needed?
• Do I also have hemorrhoids, a thrombosed external hemorrhoid, abscess or another anal disease?
• How can I improve stool consistency?
• What should I avoid during bowel movement?
• How long should I use topical treatment?
• When should I come for follow-up?
• Does botulinum toxin make sense in my case?
• Do I need pelvic floor physiotherapy?
• Which symptoms require urgent consultation?

FAQ - anal fissure, healing and treatment

How long does an anal fissure take to heal?

A fresh fissure may heal within a few weeks, especially if stool is softened quickly, straining is limited and sphincter tension is reduced. If symptoms last long or recur, the fissure may be chronic and require specialist treatment.

What helps most with an anal fissure?

The most important factors are soft stool, treating constipation or diarrhea, avoiding straining, short toilet visits, warm sitz baths and topical medicines selected by a doctor. Applying ointment alone is usually not enough if stool continues to injure the wound.

Will an anal fissure heal on its own?

It may, especially if it is fresh and the patient quickly improves stool consistency. If pain, burning or bleeding persist, worsen or return, a proctology consultation is needed.

Why does a fissure hurt after bowel movement?

Bowel movement irritates the wound, and pain triggers reflex sphincter spasm. The spasm may maintain burning and pain for many minutes or hours and worsen blood supply to the wound.

Is blood with an anal fissure normal?

With a fissure, bright red blood may appear on toilet paper or stool. However, not every bleeding should automatically be considered a fissure. Recurrent, heavy or unexplained bleeding requires diagnostics.

Does every fissure require Botox?

No. Many fresh fissures are treated conservatively. Botulinum toxin is considered in selected patients, especially with chronic fissure, strong sphincter spasm or lack of improvement after conservative treatment.

Can an anal fissure recur?

Yes. Recurrences are common if constipation, hard stool, straining, diarrhea, abnormal sphincter tension or poor toilet habits persist.

Are anal fissure and hemorrhoids the same?

No. They are different conditions, although both may cause bleeding. A fissure more often causes sharp pain during bowel movement and burning after stool. Hemorrhoids more often cause bleeding, itching, a lump or prolapse.

When should you go to a proctologist with an anal fissure?

It is worth seeing a proctologist if symptoms do not improve after a few days of self-care, last longer, return, are very painful or are accompanied by bleeding, a lump, purulent discharge or fever.

Does anoscopy hurt with a fissure?

With severe pain, the doctor may adjust the scope of examination to the patient's tolerance. Full anoscopy does not always have to be performed immediately. The most important thing is safe diagnosis and treatment planning.

Who consults anal fissure at WMP?

At Wyspa Medycyny Przyjaznej, anal fissure and other diseases of the anus and perianal area are consulted, among others, by Kamil Smok, MD, surgeon dealing with proctology.

Sources for medical and editorial verification

• Wyspa Medycyny Przyjaznej, Kamil Smok, MD: https://www.wyspamedycynyprzyjaznej.pl/pl/kamil-smok-chirurg-gdansk
• Wyspa Medycyny Przyjaznej, anal fissure - botulinum toxin treatment: https://www.wyspamedycynyprzyjaznej.pl/pl/szczelina-odbytu-leczenie-toksyna-botulinowa
• Wyspa Medycyny Przyjaznej, anal fissure or hemorrhoids: https://www.wyspamedycynyprzyjaznej.pl/pl/szczelina-odbytu-blog-gdansk
• Wyspa Medycyny Przyjaznej, proctology consultation: https://www.wyspamedycynyprzyjaznej.pl/pl/konsultacja-proktologiczna-gdansk
• Wyspa Medycyny Przyjaznej, anoscopy: https://www.wyspamedycynyprzyjaznej.pl/pl/anoskopia
• ASCRS, Management of Anal Fissures, Clinical Practice Guideline 2023: https://www.ascrsu.com/ascrs/view/ASCRS-Toolkit/2851088/all/Management_of_Anal_Fissures__2023_
• NHS, Anal fissure: https://www.nhs.uk/conditions/anal-fissure/
• Guy's and St Thomas' NHS, Anal fissure treatment: https://www.guysandstthomas.nhs.uk/health-information/anal-fissure-treatment
• Cambridge University Hospitals NHS, Anal fissures: https://www.cuh.nhs.uk/patient-information/anal-fissures/
• NICE, Chronic anal fissure - botulinum toxin type A injection: https://www.nice.org.uk/advice/esuom14
• Mayo Clinic, Anal fissure - diagnosis and treatment: https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351430
• Cleveland Clinic, Anal fissures: https://my.clevelandclinic.org/health/diseases/13177-anal-fissures
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