In many cases, anal fissures can heal fast with the help of nonsurgical treatments, such as dietary changes, over-the-counter stool softeners, and topical creams. However, they may recur if the underlying cause is not addressed.

A person holding a glass of water on a table to hydrate themselvesShare on Pinterest
Marc Tran/Stocksy

An anal fissure is a small tear or cracks in the skin lining the anus. The condition affects the areas of the anus and rectum. It causes sharp pain when passing stool and burning pain several hours after.

Medical interventions and lifestyle changes can address and heal acute anal fissures. Chronically recurring tears are more challenging to treat, as conservative treatments are more likely to fail.

This article explores different ways to treat fissures without surgery and answers frequently asked questions about treating anal fissures.

Most instances of anal fissures occur in constipated people with large or hard stools. Evidence indicates an association between low fluid intake and intestinal constipation.

Drinking enough water daily prevents dehydration, while not drinking enough can lead to harder stools that are more difficult to pass.

The National Academy of Medicine’s daily fluid recommendation for males and females is 13 and 9 cups, respectively.

A 2018 study on reducing postoperative constipation found that increases in fluid and fiber intake significantly reduce the risk of developing constipation.

Learn more about constipation here.

Caffeine is a diuretic. Diuretics help the body get rid of excess water and salt.

However, caffeine’s diuretic effect can cause dehydration, which could result in anal fissures.

Current research does not fully support this, though. Data suggests that in some people, more than 180 milligrams of coffee — two cups of brewed caffeinated coffee — daily may increase urination in the short term but will not necessarily lead to dehydration.

As stated above, an adequate intake of daily fluids is about 13 and 9 cups for healthy males and females, respectively, with 1 cup equaling 8 ounces.

Therefore, caffeinated beverages, including coffee and tea, can contribute to a person’s total daily water intake. However, in general, they account for less than that amount and may not affect a person’s hydration state.

Learn more about what alternatives there are to caffeine.

A 2015 study shows that a high fiber diet effectively treated 87% of acute anal fissures in 3 weeks, and continuing the diet for 1 year, prevented their recurrence.

Consuming 20–30 grams of soluble and insoluble fibers can help prevent constipation. Soluble fiber adds bulk to stool, while insoluble fiber helps speed up the transit time of food in the digestive tract.

Flaxseed and psyllium can help improve constipation. Taking fiber supplements, such as Metamucil, Citrucel, and Konsyl is also helpful.

See a list of high fiber foods here.

Sitz baths involve soaking in warm water in a tub for 10–20 minutes. Baths relax the sphincter muscles and help soothe the pain from fissures. For maximum benefits, a person would do this several times daily, especially after every bowel movement.

Aside from pain relief, sitz baths also promote healing, with around an 80% recovery rate.

Straining to pass hard stools often causes cracks or tears in the anus. The following are ways to pass stool without straining:

  • Sit with a straight back while leaning forward to lean the forearms on the knees. Keep the legs apart and the knees higher than the hips by using a footstool or lifting the heels.
  • Brace the abdominal muscles with every urge.
  • Keep the mouth slightly open and breathe out. One should not hold their breath when passing stool.

Laxatives can help people pass stool more easily.

Doctors typically prescribe laxatives with bulk-forming agents to adults with anal fissures. These help the stool retain fluid, making it less likely to become hard and dry.

Doctors usually prescribe osmotic laxatives polyethylene glycol (PEG), such as MiraLAX, to children with anal fissures to increase fluid in their bowels and stimulate their need to pass stool.

A 2020 study found that using PEG alone had similar effects in children than using PEG combined with topical agents.

Doctors may also recommend OTC stool softeners, such as docusate (Colace).

Read more about the difference between laxatives and stool softeners.

Applying topical anesthetics, such as lidocaine, to the skin around the anus can help provide pain relief.

Hydrocortisone, a steroid, can also help treat itching, pain, swelling, and discomfort in the anal area.

Topical nitrates, for example, nitroglycerine, will help relax the muscles around the anus and increase blood flow to the fissure to promote healing.

Healing may take 6–8 weeks but may require 12 weeks.

Calcium channel blockers, such as diltiazem and nifedipine, can also help relax the anal sphincter.

Medical professionals may prescribe this drug in a topical form that they can apply to the skin, but they may also prescribe oral medications.

A 2020 study found that these drugs are more effective in treating anal fissures than topical anesthetics alone.

Anecdotal evidence suggests this drug for anal fissures is an off-label use; more research is necessary to determine its effectiveness.

A botulinum toxin (Botox) injection paralyzes the internal anal sphincter for about 3–4 months, which should be enough for the fissure to heal completely.

It has a 60–80% healing rate. However, people treated with a Botox injection tend to recur up to 42% of the time.

It is important to note that Botox is an off-label drug for the treatment of fissures. People should discuss on-label methods with a doctor to help treat the condition.

Generally, the treatment or home remedies are effective if a person no longer experiences symptoms associated with anal fissures.

A 2020 study found that the two most common complaints from participants were pain and bleeding while passing stool.

A person experiencing pain during or after defecation, with or without bleeding, should go to a doctor. They will perform a thorough physical exam to identify its cause.

People with anal fissures should inform a doctor if they have new or worse pain or bleeding.

They should also immediately call a doctor if they have severe symptoms or show no improvement after 8 weeks of treatment.

Below are some frequently asked questions on anal fissure treatments.

When will a person require surgery for anal fissures?

Most anal fissures do not require surgery. However, chronic anal fissures are typically more challenging to treat.

Doctors may recommend surgery in people with fissures that are chronic or complicated, recurring despite lifestyle changes and medical treatments, and those accompanied by severe pain.

Can natural remedies help treat chronic fissures?

Only about 50% of those with chronic fissures respond to conservative treatments. Natural remedies, such as laxatives and sitz baths, are more effective in treating acute, rather than chronic, fissures.

Another study found natural remedies and medical treatments for chronic anal fissures provide temporary relief but have high recurrence rates.

Why do some fissures not heal with natural remedies?

Anal fissures tend to cause a vicious cycle. Acute injury leads to pain and spasms of the internal anal sphincter. This leads to reduced blood flow and poor healing. Fissures persist when this cycle remains unbroken.

Fissures also tend to recur when the factors that cause them persist. Examples include constipation or an underlying condition, such as Crohn’s disease.

Can fissures return after surgery?

Fissures can return or recur after surgery, but it is rare, occurring in up to 6% of those who underwent surgery to treat the fissure.