Anal Fissure: Causes, Signs and Effective Treatment

Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP

What is an anal fissure?

An anal fissure is a tear or crack in the lining of the lower rectum (anal canal) that causes pain during bowel movements. Fissures are sometimes confused with hemorrhoids. Most anal fissures heal with home treatment after 4-6 weeks. These are called short-term (acute) anal fissures.

What are the common causes of anal fissures?

Anal fissures can be caused by trauma to the anus and anal canal. The trauma can be caused by one or more of the following:

  • Chronic (long-term) constipation
  • Straining to have a bowel movement, especially if the stool is large, hard and/or dry
  • Prolonged diarrhea
  • Insertion of foreign objects into the anus

What are the signs and symptoms of an anal fissure?

Signs and symptoms of an anal fissure include:

  • Pain during, and even hours after, a bowel movement
  • Constipation
  • Blood on the outside surface of the stool
  • Blood on toilet tissue or wipes
  • A visible crack or tear in the anus or anal canal
  • Burning, throbbing and itching that may be painful

 How are anal fissures treated?

The goal of anal fissure treatment is to lower the pressure on the anal canal by making stools soft, and to ease discomfort and bleeding. This can be accomplished by taking Docusate sodium (Colace) every 12 hours. Conservative treatments are tried first and include one or more of the following:

  • Preventing constipation through the use of stool softeners (Colace) and dietary adjustments (increase in intake of high fiber foods and fiber supplements); Citrucel is a good fiber therapy.
  • Soaking in a warm bath (also called a sitz bath), 10 to 20 minutes several times a day, to help relax the anal muscles;
  • Cleansing the anorectal area more gently;
  • Avoiding straining or prolonged sitting on the toilet;
  • Using petroleum jelly to help lubricate the anorectal area.
  • Applying creams and ointments. These may include a medicated cream (to help heal the fissure), a topical muscle relaxant (to relax the anal muscles), an anesthetic ointment (to reduce pain, if pain interferes with having a bowel movement), or calcium channel blocker ointments (to relax the anal muscles and increase blood flow to the region, promoting healing).

Apply Forces of Nature – Natural, Organic Fissure Care– this is a combination of homeopathic and botanical ingredients. It is quite effective and recommended to apply 4-6 times a day.

If the fissure persists after 6 weeks applying the above treatment regimen, surgery may be necessary. It would be necessary to see a GI specialist.

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Grisanti and his functional medicine community. Dr. Grisanti encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. Visit for more information on our training in functional medicine. Look for practitioners who have successfully completed the Functional Medicine University’s Certification Program (CFMP) This content may be copied in full, with copyright, contact, creation and information intact, without specific permission, when used only in a not-for-profit format. If any other use is desired, permission in writing from Dr. Grisanti is required


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