Digestive Health More Digestive Diseases Anal Fissure Guide Anal Fissure Guide Overview Causes Treatment Self-Care and Prevention Anal Fissure Self-Care and Prevention Home Remedies and Over-the-Counter Treatments By Amber J. Tresca Updated on September 20, 2023 Medically reviewed by Robert Burakoff, MD Print Table of Contents View All Table of Contents Symptoms Causes Home Remedies Caring for Perianal Skin Prevention Next in Anal Fissure Guide What Is an Anal Fissure? Home remedies for anal fissures include sitz baths, fiber supplements, stool softeners, and adequate hydration and fiber intake. An anal fissure is a tear or a break in the lining of the anal canal, where stool passes out of the body. They are painful and may bleed, causing so much discomfort that they can affect your quality of life. Many anal fissures heal on their own or with the assistance of things like dietary changes and home remedies. However, deeper fissures that persist may require treatment from a healthcare provider. This article explains the more common symptoms and causes of anal fissures. It also offers solutuions to treat fissures yourself, as well as how to prevent them from coming back. Westend61 / Getty Images Anal Fissure Symptoms Anal fissures happen when there has been some type of injury to the anal canal. This trauma to the anal lining is what leads to symptoms such as: BleedingDiscomfortPain with bowel movements Blood in the stool, on the paper after you wipe, or in the toilet bowl should be evaluated by a gastroenterologist (a digestive health specialist) or your healthcare provider. Even if you've had fissures in the past and know the signs, anal bleeding should be examined by a doctor to confirm you do not have a more serious condition, Causes Tears in the anal canal can happen to anyone, but they're more common in younger people who appear to be otherwise healthy. In the past, anal fissures were thought to be caused by straining to pass stool. However, the underlying cause is now considered tense anal sphincter muscles. Too much tension can lead to a fissure, leading to pain, spasms, and more tension, creating an ongoing cycle. Anal fissures can be primary or secondary. Primary anal fissures are usually benign (not harmful), located in the back (posterior) or front (anterior) of the anus, and due to local trauma. Common causes of primary anal fissures include: Childbirth, especially after a difficult or instrument-assisted deliveryChronic diarrheaConstipationHard stoolsPenetrationRepetitive injury Secondary anal fissures are typically found on the side (lateral) of the anus, and multiple cracks can occur. Secondary anal fissures are often due to a more serious underlying cause, such as: Cancer Crohn's or inflammatory bowel disease HIV/AIDS Hypothyroidism Infections Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis Obesity Previous anal surgery Sarcoidosis Syphilis Tuberculosis Home Remedies for Anal Fissures Anal fissures are painful, in part, because people who have them still need to move their bowels while they're healing. It is important to keep stools soft and make it easier for them to pass out of the body so the fissure is not further irritated by bulk or straining. There are other self-care measures that may help reduce the pain of anal fissures while allowing them to heal more quickly. Treatment at home for uncomplicated anal fissures can include eating more fiber, using stool softeners, and drinking more water. Options also may include using sitz baths and a local anesthetic to decrease pain. Sitz Baths Sitz baths, available at most drugstores, are essentially small plastic tubs. You fill the tub with a few inches of warm water, place it atop a toilet seat, then sit on it, allowing your anal area to soak in the water. Soak in a sitz bath for 10 to 15 minutes two or three times a day. While it will not speed healing, it can help to ease the pain and discomfort of anal fissures. In some cases, Epsom salts or other products may be added to the water in the sitz bath. However, these should only be used with a healthcare provider's approval. You can use your bathtub if you don't have access to a plastic sitz bath. If you do, be sure to clean your bathtub well before your sitz soak and keep to the recommended soaking time. How to Use a Sitz Bath Topical Treatments Drug store topical treatments can help soothe the perianal area and relieve the pain of anal fissures. The American Academy of Family Physicians recommends the following over-the-counter remedies for anal fissures: 1% hydrocortisone creamPetroleum jellyPreparation HZinc oxide You can also ask your healthcare provider about numbing cream, which can make bowel movements less painful. Dietary Fiber The Academy of Nutrition and Dietetics recommends that adult males and females get at least 38 grams (g) and 25 g of fiber per day, respectively. However, many adults in the United States do not regularly achieve this goal. Eating the right amount of fiber helps prevent stools from being too hard and causing constipation. It also keeps stools from being too liquid and causing diarrhea. Insoluble fiber, in particular, can help soften stools and improve digestion. A soft, easily passed stool will be less hard on the fissure and keep it from getting even more irritated. High-Fiber Foods High-fiber bran cereal Various beans Shredded wheat cereal Split peas Wheat bran flakes Chickpeas Plain rye wafer crackers Lentils Pumpkin seeds Artichokes Soybeans Pigeon peas Cowpeas Avocado Foods to Avoid Along with eating more fiber to make stools easier to pass, you should also avoid certain foods that may make BMs more painful. Avoid hot and spicy foods, like cayenne pepper. Any foods or spices that cause heat in your mouth can feel like fire to an anal fissure. Nuts, popcorn, and tortilla chips can also be problematic. These foods are high in difficult-to-digest soluble fiber, which creates a rough passage through the digestive system and can feel sharp against anal fissures. Fiber Supplements If you can't get enough fiber from the foods in your diet, a fiber supplement may help. Fiber supplements come in various forms but with the common ingredients of psyllium, methylcellulose, and polycarbophil. Start slowly with fiber supplements and increase the amount used over time. This will help you avoid side effects like abdominal bloating and gas. It may take some trial and error to understand which fiber supplement at what dosage is the right one for you. Fiber supplements can be taken long-term. They are helpful in treating constipation and diarrhea, both of which can lead to anal fissures. Stool Softeners A stool softener may help you avoid constipation by pulling more water into the digestive tract to soften stool. They are associated with few side effects and are generally considered safe. Stool softeners are not the same as laxatives. Stool softeners come in liquid, capsule, and tablet forms. Most people usually use them for about a week. Other lifestyle changes should be put in place to help with constipation, too. This is so you can eventually stop using the stool softeners. Check with a healthcare provider about which over-the-counter stool softener treats anal fissures most effectively. Drinking More Water Dehydration, or not having enough water in your body, can contribute to constipation. Drinking water can help keep stools soft and make them easier to pass. Foods with a lot of water in them, like fruits and vegetables, also add to your overall water intake. Foods With High Water Content Broccoli Spinach Cabbage Strawberries Cantaloupe Sweet peppers Celery Tomato Cucumber Watermelon Lettuce Zucchini Recommended daily water intake depends on the person, so ask your healthcare provider what they suggest for you. That said, it may be that your own body is the best gauge for how much water you need. When stools are soft and easily passed, it may mean that you have enough overall water in your diet. Caring for Perianal Skin Keeping clean after bowel movements can be a challenge when you have a fissure. If wiping is causing pain, try using a bidet, a hand shower, or peri bottle. These may be gentler on your irritated skin. Instead of toilet paper, try fragrance-free wet wipes or alcohol-free baby wipes. Wipes are gentler on delicate perianal skin, but remember not to flush them so they don't clog your plumbing. Soft flannels or washcloths may help, too, if you don’t mind doing some extra laundry. (Wash separately in hot water.) Preventing Anal Fissures If you're prone to getting anal fissures, prevention is key. The measures used to treat an anal fissure may help in preventing one as well: Avoid straining during bowel movements. Try to consciously relax the muscles in the anal canal during a bowel movement. This can help you to avoid the increase in sphincter tone that may lead to fissures. Go to the bathroom when you feel the urge. Holding on to a bowel movement for a long period can mean that it becomes harder to pass. Avoid this. Ask your healthcare provider about bowel retraining. This involves going to the bathroom on a schedule in an effort to get the body to have regular bowel movements. This may particularly help those who live with bowel conditions like chronic constipation or related irritable bowel syndrome (IBS). Summary Anal fissures can be caused by constipation, diarrhea, childbirth, and other health concerns and can often be treated effectively at home. It's important to treat fissures and their causes before they become chronic and are harder to heal. Getting more fiber (through your diet or supplements), drinking more water, and using a stool softener can ease bowel movements. This can reduce the pain of having a bowel movement when you have a fissure and may even prevent future fissures. Taking a sitz bath, topical numbing creams, petroleum jelly, and Preparation H can help to ease the pain and discomfort of anal fissures. 13 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Johns Hopkins Medicins. Anal fissures. Gardner IH, Siddharthan RV, Tsikitis VL. Benign anorectal disease: hemorrhoids, fissures, and fistulas. Ann Gastroenterol. 2020;33:9-18. doi:10.20524/aog.2019.0438 Schlichtemeier S, Engel A. Anal fissure. Aust Prescr. 2016;39(1):14–7. doi:10.18773/austprescr.2016.007 Mapel DW, Schum M, Von Worley A. The epidemiology and treatment of anal fissures in a population-based cohort. BMC Gastroenterol. 2014;14:129. doi:10.1186/1471-230X-14-129 Sugerman DT. Anal fissure. JAMA. 2014;311(11):1171. doi:10.1001/jama.2014.214 U.S. National Library of Medicine: MedlinePlus. Anal fissures. American Academy of Family Physicians: FamilyDoctor.org. Anal fissure. Academy of Nutrition and Dietetics. Fiber. Cedars-Sinai. Anal fissures. University of California–San Francisco Health. Patient education: Fiber supplements. U.S. National Library of Medicine: MedlinePlus. Stool softeners. American Society of Colon & Rectal Surgeons. Anal fissure expanded information. University of Rochester Medical Center. Anal fissure. Additional Reading U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2020 – 2025 Dietary Guidelines for Americans. By Amber J. Tresca Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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