Anal fissure treatment

What is treatment for an anal fissure?

An anal fissure is a small tear in the skin lining the anus, usually caused by passing a hard or large stool. It causes a sharp, tearing pain when you open your bowels and often a streak of bright red blood. Many fissures heal on their own.

The pain makes the muscle around the anus go into spasm, which reduces blood flow to the tear and stops it healing — so most treatments work by relaxing that muscle and keeping stools soft, giving the skin a chance to heal. Treatment is stepped: simple measures and creams first, then a botulinum toxin injection or a small operation if the fissure does not settle.

Treatment does not change why the fissure started. If constipation, diarrhoea or another condition caused it, that needs addressing too, or the fissure can come back. Some fissures point to an underlying problem (such as inflammatory bowel disease or, rarely, an infection), which is why a clinician should examine you rather than assume every tear is a simple fissure.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Botulinum toxin versus sphincterotomy

Surgery is more reliable but cuts muscle; the injection avoids that but may need repeating. Your surgeon should explain which suits you.

Preparing for your procedure

• Have the fissure examined by a clinician to confirm the diagnosis and check for any underlying cause.
• Start and stick with stool-softening measures — fluids, fibre and laxatives if advised — as these help every treatment work.
• If using a cream, ask how to apply it and what side effects (such as headache with GTN) to expect.
• For a procedure, follow fasting instructions and arrange a lift home after a general anaesthetic.
• Tell the team about all medicines, including blood thinners, and any bowel condition.
• Plan good pain relief and a way to keep the area clean at home.
• Ask whether a procedure is likely to be a one-off or might need repeating.

What happens

Treatment usually starts with simple measures and a cream you apply yourself for several weeks. You will be advised on keeping stools soft, warm baths and pain relief.

If the fissure does not heal, a procedure may be offered. A botulinum toxin injection or a lateral internal sphincterotomy is usually done under a short general anaesthetic as a day case and takes only a few minutes. For sphincterotomy, the surgeon makes a tiny cut in the inner anal muscle to release the spasm. For botulinum toxin, the muscle is injected to relax it temporarily.

You wake up in recovery and, once comfortable, go home the same day with advice on aftercare.

Is this procedure right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

The risk that matters most is with sphincterotomy, which cuts a small amount of muscle: most people have no lasting problem, but some report difficulty controlling wind, and a smaller number report leakage. Because of this, creams and botulinum toxin (which do not cut muscle) are usually tried first. Ask your surgeon how likely any change in bowel control is for you, and whether a muscle-sparing option is suitable.

Published figures to discuss

Healing rates depend on whether a fissure is acute or chronic, how soft stools are kept, and which treatment is used. Surgery heals the most fissures but is the only common treatment that carries a lasting risk to continence, because it divides a small amount of muscle. Reported figures vary between studies and over time, so they should be treated as a guide.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

Creams need no recovery, though they take several weeks to work. After a botulinum toxin injection or sphincterotomy most people go home the same day and are back to normal within a few days, but the fissure itself takes a few weeks to heal fully.

• Headache when starting GTN ointment
• Mild soreness and a little spotting of blood after a procedure
• The fissure taking a few weeks to settle even after treatment
• Some itching as the area heals

Aftercare

• Keep stools soft with fluids, fibre and laxatives if advised — this is the single most important thing for healing.
• Use any cream exactly as directed, and report side effects such as severe headache.
• Bathe or gently shower the area daily and after opening your bowels; avoid perfumed soaps.
• Take painkillers as needed, including before bowel movements if they are painful.
• Avoid straining and sitting for long periods where you can.
• Keep follow-up appointments to check the fissure has healed.
• Know who to contact if pain worsens, bleeding is heavy, or you develop a fever.

• Stool softeners or laxatives and a high-fluid, high-fibre plan
• Prescribed cream collected and instructions understood
• Painkillers at home
• Warm-bath routine planned
• Lift home if you are having a procedure under general anaesthetic
• Time off arranged if needed
• Clinic contact number saved

Scars and how they heal

Creams and injections leave no scar. Lateral internal sphincterotomy involves a tiny cut near the anus that usually heals with a small, discreet scar. A fissurectomy leaves a small wound that heals over a few weeks.

⚠ Get urgent help if…

• Severe or worsening pain that does not settle with treatment
• Heavy or persistent bleeding
• Fever, chills or feeling generally unwell (possible infection)
• A new swelling, lump or discharge of pus near the anus
• New or worsening difficulty controlling wind or stool
• Bleeding with a change in bowel habit or weight loss — get this checked, as it needs ruling out for other causes

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

Many fissures heal within a few weeks using stool-softening measures and a cream. When creams do not work, a botulinum toxin injection helps a good proportion, and lateral internal sphincterotomy heals most chronic fissures — but at the cost of a small risk to bowel control.

A good outcome is a healed, pain-free fissure with normal bowel control. Because treatment does not change what caused the fissure, keeping stools soft afterwards matters for staying healed. Persistent bleeding or a change in bowel habit should always be assessed, because not everything that looks like a fissure is one.

Fissures often heal for good once the cause (such as constipation) is managed and the skin has healed. However, they can recur, particularly if stools become hard again or an underlying condition is not controlled. GTN-healed fissures in particular have a notable rate of coming back over time. Sphincterotomy gives the most durable healing for chronic fissures but is reserved for those that do not respond to less invasive options.

Related tests, treatments or support

Botulinum toxin is sometimes combined with a fissurectomy (trimming the edges of a long-standing fissure) to improve healing without cutting muscle. Stool-softening measures are combined with every other treatment. If an examination raises the possibility of another condition, a colonoscopy or specialist review may be arranged.

Follow-up & long-term care

You will usually be reviewed after a course of cream or after a procedure to check the fissure has healed. If it has not, the next step on the ladder is considered. Persistent symptoms, or any features that do not fit a simple fissure, prompt further investigation.

• Keep stools soft long-term with fluids, fibre and laxatives if needed.
• Avoid straining and prolonged sitting on the toilet.
• Treat constipation or diarrhoea promptly to reduce the chance of a new fissure.
• See your clinician if pain or bleeding returns rather than assuming it is the same fissure.

Repeat, follow-on and what comes next

• Botulinum toxin wears off after a few months; some people need a repeat injection.
• A fissure that does not heal with one treatment may need to be stepped up to the next option.
• Sphincterotomy is usually a one-off, but a non-healing or recurrent fissure should be reassessed for another cause.
• Recurrent fissures often signal that stools are not being kept soft enough.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• Clear advice on keeping stools soft, with a fibre, fluid and laxative plan.
• Written guidance on using creams and what side effects to expect.
• A named contact route for worsening pain, heavy bleeding or signs of infection.
• Follow-up to confirm healing and to plan the next step if needed.
• Clear advice to seek review for bleeding or a change in bowel habit, rather than assuming it is the fissure.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Whether you need only creams and advice, or a procedure.
• The clinician's fee and the type of treatment (injection or surgery).
• Anaesthetic and theatre or facility fees for any procedure.
• The cost of prescribed creams and laxatives.
• Whether further investigation, such as a colonoscopy, is needed to rule out other causes.
• Follow-up appointments to confirm healing.
• Whether a procedure such as botulinum toxin may need repeating.

• The clinician's fee and which treatment is planned
• Anaesthetic and facility fees if a procedure is involved
• Cost of any prescribed creams or laxatives
• Follow-up appointments to check healing
• Whether a botulinum toxin injection may need repeating and how that is charged
• Cancellation policy
• What happens, and what it costs, if the fissure does not heal or a complication occurs

On the NHS? Anal fissure treatment is commonly available on the NHS; some people use private care for faster access or to choose their surgeon.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the surgeon is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the surgeon who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Have you confirmed this is a simple fissure, and could there be an underlying cause?
• Which treatments should I try first, and how long before we move to the next step?
• If I need a procedure, would botulinum toxin or sphincterotomy suit me better, and why?
• What is the chance a sphincterotomy affects my bowel control?
• How can I keep my stools soft so the fissure heals and stays healed?
• What should I watch for, and when should I come back if it does not heal?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my procedure, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this procedure not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for anal fissure treatment

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Anal fissure NICE — Chronic anal fissure: glyceryl trinitrate (intervention and alternatives) NICE — Chronic anal fissure: 2% topical diltiazem (information for the public) Cambridge University Hospitals NHS — Anal fissures

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.