Anal Fissure: Why It Won't Heal & Medically Approved Next Steps

An anal fissure is a small tear in the lining of the anus. While it may sound minor, it can cause sharp pain, burning, and bleeding during or after bowel movements. Many anal fissures heal within a few weeks. But when they don't, it can be frustrating and concerning.

If you're dealing with an anal fissure that won't heal, here's what you need to know — and what medically approved next steps can help.

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What Is an Anal Fissure?

An anal fissure is a split or tear in the thin tissue (mucosa) that lines the anus. It often happens when:

• Passing hard or large stools
• Straining during bowel movements
• Chronic constipation
• Chronic diarrhea
• Childbirth
• Anal injury

Common symptoms include:

• Sharp pain during bowel movements
• Burning or throbbing pain afterward (can last minutes to hours)
• Bright red blood on toilet paper or stool
• A visible crack or tear near the anus
• A small lump or skin tag near the fissure (in chronic cases)

Acute anal fissures typically heal within 4–6 weeks. When a fissure lasts longer than 6–8 weeks, it is considered chronic.

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Why Your Anal Fissure Isn't Healing

If your anal fissure won't heal, there's usually a reason. Here are the most common causes.

1. Ongoing Constipation or Hard Stools

Every time a hard stool stretches the anal canal, it can reopen the tear. Even if healing begins, repeated trauma resets the process.

Chronic constipation is one of the main reasons fissures become long-term problems.

2. Persistent Muscle Spasm

The anal sphincter muscle can go into spasm after a fissure forms. This spasm:

• Reduces blood flow to the area
• Increases pain
• Slows healing

Poor blood supply makes it harder for the tissue to repair itself.

3. Chronic Inflammation

Conditions like:

• Inflammatory bowel disease (IBD)
• Crohn's disease
• Chronic diarrhea

can prevent healing and may cause recurrent fissures.

4. Infection or Complications

Though uncommon, infection or improper hygiene can delay healing.

5. Incorrect Self-Treatment

Some over-the-counter creams are not appropriate for fissures. Using products that irritate the skin may worsen symptoms.

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When to Take Symptoms Seriously

While most anal fissures are not dangerous, certain symptoms require medical attention.

Speak to a doctor promptly if you have:

• Heavy or ongoing rectal bleeding
• Fever
• Severe worsening pain
• Pus or unusual discharge
• Unintended weight loss
• A history of inflammatory bowel disease

Rectal bleeding should never be ignored, even if you suspect an anal fissure. Other conditions — including hemorrhoids, infections, or rarely colorectal cancer — can cause similar symptoms. A proper medical evaluation is important.

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Medically Approved Next Steps for Healing

If your anal fissure hasn't healed, here's what doctors typically recommend.

1. Soften the Stool (This Is Critical)

The single most important step is preventing hard bowel movements.

You can do this by:

• Increasing fiber intake (25–35 grams per day)
  • Fruits
  • Vegetables
  • Whole grains
• Drinking 6–8 glasses of water daily
• Using a doctor-recommended fiber supplement if needed
• Using stool softeners (as advised by a healthcare provider)

Consistency matters. Even one episode of straining can reopen the fissure.

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2. Warm Sitz Baths

Soaking in warm water for 10–20 minutes:

• Relaxes the anal sphincter
• Improves blood flow
• Reduces pain

This simple step can significantly improve healing.

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3. Prescription Topical Medications

If conservative care isn't enough, doctors may prescribe medicated creams that:

• Relax the anal sphincter
• Increase blood flow
• Reduce muscle spasm

Common prescription options include:

• Topical nitroglycerin
• Topical calcium channel blockers (like diltiazem or nifedipine)

These treatments are medically approved and often effective for chronic anal fissure.

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4. Botox Injection

In cases where muscle spasm is severe, a doctor may inject botulinum toxin (Botox) into the anal sphincter. This:

• Temporarily relaxes the muscle
• Improves blood supply
• Allows healing

It is less invasive than surgery and often successful.

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5. Surgical Treatment (For Severe or Chronic Cases)

If an anal fissure does not respond to other treatments, a minor surgical procedure called lateral internal sphincterotomy may be recommended.

This procedure:

• Relaxes the tight muscle
• Improves blood flow
• Has a high healing success rate

While surgery can sound intimidating, it is commonly performed and often provides lasting relief. Your doctor will discuss risks and benefits with you.

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Lifestyle Changes That Support Healing

Small daily habits can make a big difference.

Avoid Straining

• Don't sit on the toilet for long periods
• Go when you feel the urge
• Avoid pushing

Improve Bathroom Posture

Using a small footstool to elevate your feet can create a more natural bowel position and reduce strain.

Gentle Hygiene

• Avoid harsh soaps
• Use unscented wipes or water
• Pat dry instead of rubbing

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Could It Be Something Else?

Symptoms of an anal fissure can overlap with:

• Hemorrhoids
• Perianal abscess
• Crohn's disease
• Anal infection
• Less commonly, anal cancer

If you're experiencing symptoms and want to better understand whether they align with an Anal Fissure, a free AI-powered symptom checker can help you quickly evaluate your condition and determine if you should seek medical care.

However, an online tool does not replace a medical evaluation. If symptoms persist, worsen, or feel severe, speak to a doctor.

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How Long Should Healing Take?

• Acute anal fissure: 4–6 weeks
• Chronic anal fissure: May take longer and often needs prescription treatment

If you've been treating symptoms for more than 6–8 weeks without improvement, it's time to see a healthcare provider.

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Preventing Recurrence

Once healed, prevention is key.

Focus on:

• Daily fiber intake
• Proper hydration
• Regular bowel habits
• Managing chronic digestive conditions

People who return to straining or constipation often experience repeat fissures.

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When to Speak to a Doctor

Do not delay medical care if:

• Pain is severe
• Bleeding continues
• You feel faint or weak
• Symptoms last more than several weeks
• You have other concerning symptoms

Rectal bleeding and severe pain should always be evaluated to rule out serious causes. While an anal fissure is common and usually treatable, other conditions can look similar and may be life-threatening if ignored.

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The Bottom Line

An anal fissure that won't heal usually means one thing: the underlying cause hasn't been addressed. Ongoing constipation, muscle spasm, or inflammation can keep reopening the tear.

The good news is that most anal fissures — even chronic ones — respond well to proper medical treatment. You do not have to live with ongoing pain.

Start with stool softening, hydration, and sitz baths. If that doesn't work, speak to a doctor about prescription options or other treatments. Early care often prevents the need for surgery.

If you're unsure whether your symptoms match an anal fissure, consider using a free online symptom tool to better understand your situation. And most importantly, talk to a healthcare professional about any persistent, severe, or life-threatening symptoms.

Relief is possible — but taking the next step matters.