Pain in the backside isn’t something to take sitting down, with treatment and advice readily available for this extremely common condition.
What are anal fissures?
Affecting around one in 10 Australians, anal fissures are tears in the delicate lining of the anal canal.1-2 Often likened to a “paper cut”, these tiny injuries in such a sensitive part of the body really do hurt and that sharp, sudden pain is usually the first sign something is not quite right with your bottom.3 In fact, international research shows anal fissures are the most frequent cause of severe anorectal pain.4 While often worst when using the toilet, pain from an anal fissure can continue, sometimes for hours.5 Other typical signs of anal fissure include bright red blood on toilet paper or drops of blood in the toilet bowl.1-5
Who is predisposed to anal fissures?
Adults of all ages and genders can experience anal fissures.3 Any activity that causes trauma to the very sensitive lining of the anal canal can cause tissue damage and painful muscle spasm.5 That includes straining when going to the toilet, anal intercourse without lubricant and childbirth.1 Injury due to vaginal delivery is a particularly common cause of anal fissure due to sustained pressure on the perineum and anus while birthing.1-2 It’s also not unusual to notice an anal fissure has developed following illness involving constipation, diarrhoea or both.5
How do anal fissures differ to haemorrhoids?
Anal fissures are small tears in the lining of the anal canal.6 Initial treatment options include an ointment such as Rectogesic – only available at pharmacies – to improve blood flow to the area to promote healing of the tear.6 If it doesn’t resolve, your GP may suggest further treatments such as botox injections or a surgical day procedure to repair the fissure if necessary.6-7
Haemorrhoids are irritated and swollen blood vessels in the rectum or anus.7 While they can be uncomfortable and may bleed, they’re less likely to cause severe pain than anal fissures. 7 Initial treatment of haemorrhoids focuses primarily on managing constipation.7
How long does it take for anal fissures to resolve?
Anal fissures often resolve in about six weeks but it can take longer, and sometimes they do come back again.6-9 Some people may benefit from taking over-the-counter analgesia such as a paracetamol or ibuprofen to manage the pain, so talk to your pharmacist to find out if this is suitable option for you.1
And never put off seeking professional help for anal fissures at any sign of pain or blood from your bottom. Research shows the pain and worry associated with anal fissures can affect mood and intimate relationships so it’s worth seeking advice and treatment from your pharmacist or GP early.10
What treatment is available for anal fissures and how does it work?
For many people, anal fissures can be successfully managed with support of a pharmacist using an ointment such as Rectogesic (always seek advice from your pharmacist to help choose the treatment that’s right for you). This pharmacist-only ointment doesn’t require a prescription and contains an ingredient called glyceryl trinitrate to relax the muscle of the anal sphincter and improve blood flow to the area.4-7 This dual action reduces pain and boosts healing of the fissure. 4-7 Used three times daily for two weeks, this medicated ointment often leads to resolution of the anal fissure although some people may need to use it for longer.6 To find out if this treatment option is right for you, talk to your pharmacist.
Questions your pharmacist might ask when discussing anal fissures are what kind of symptoms you’re experiencing, when they first began, whether you’ve tried anything to treat the condition, how severe the pain is and what makes it worse. They will also take medical history and want to know whether you’re using any medications since constipation can be linked to medicines used for common conditions (e.g. pain, depression, high blood pressure). And remember, most pharmacies have a private consultation room available for precisely these kind of conversations.
What else can I do to make living with an anal fissure more comfortable?
Brief warm-water baths can be helpful to relieve pain from the muscle spasm associated with anal fissure.6 If you’re going to soak, don’t linger too long and use fragrance-free bath products to limit the risk of skin irritation to an already sensitised area.
Keeping the bottom clean and dry is also important but take care to wipe gently.3,5 Some people find cleansing wipes available from pharmacies more useful than toilet paper since they are pre-softened with cleansing, soothing and comforting ingredients. Ask your pharmacist if these fragrance-free and alcohol-free wipes could be suitable for you when managing anal fissures.
Developing good toilet habits also has a role to play in managing anal fissures and reducing the likelihood of recurrence.6-9 Pay attention to your body’s natural rhythms and don’t put off the urge to use the toilet.8
What role does diet and exercise play in managing anal fissures?
Ultimately, preventing constipation by improving your gastrointestinal health will make a lasting difference to healing an anal fissure and preventing recurrence. To give your digestion a boost, increase your daily intake of water, fruit and fibre.6,8,9 Research also shows revving up your activity levels to meet the recommended minimum 150 minutes of exercise each week since regular exercise can lead to regular, more comfortable bowel motions, too.8
When should I seek help from GP for anal fissures?
Any change in bowel habits is worth discussing with your GP, especially if you’re 50 or older.7 Symptoms to be aware of are bloody bowel motions, black coloured stools, going to the toilet less frequently than is usual for you, feeling like your bowel is still full even after passing a motion, bloating, nausea and loss of appetite.
When you see your GP to discuss whether you have anal fissures, they will ask about your symptoms, toilet habits, nutrition, activity levels, medical history and medications. They may also suggest a physical examination and request further tests such as a colonoscopy to exclude conditions such as colorectal polyps and inflammatory bowel syndrome.7,9 Your GP is available to help any time you’re concerned about your health so always reach out if you’re worried.
- Newman M, Collie M. Anal fissure: diagnosis, management, and referral in primary care. Br J Gen Pract. 2019 Aug;69(685):409-410. Accessed August 27, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6650108/pdf/bjgpaug-2019-69-685-409.pdf
- Davids JS, Hawkins AT, Bhama AR, Feinberg AE, Grieco MJ, Lightner AL, Feingold DL, Paquette IM. Clinical practice guidelines committee of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 2023 Feb 1;66(2):190-199. Accessed A October 3, 2023. https://fascrs.org/ascrs/media/files/Education/2023-Anal-Fissures-CPG.pdf
- Health Direct. Anal fissure. June 2022. Accessed October 4, 2023. https://www.healthdirect.gov.au/anal-fissure
- Boland PA, Kelly ME, Donlon NE, et al. Management options for chronic anal fissure: a systematic review of randomised controlled trials. Int J Colorectal Dis. 2020;35:1807-1815. doi:10.1007/s00384-020-03699-4
- Colorectal Surgical Society of Australia and New Zealand. Anal fissure. Accessed October 4, 2023. https://cssanz.org/Web/Web/Patients-Public/Condition-Information.aspx?hkey=c7f36001-d063-4b69-8638-0cf7ead8665f
- Lu Y, Kwaan MR, Lin AY. Diagnosis and Treatment of Anal Fissures in 2021. JAMA.2021;325(7):688–689. doi:10.1001/jama.2020.16705
- Daniel WJ. Anorectal pain, bleeding and lumps. Aust. Fam. Physician. 2010;38(6). Accessed October 3, 2023. https://www.racgp.org.au/getattachment/9d1842b4-e59f-43ff-bad7-464f39836048/Anorectal-pain-bleeding-and-lumps.aspx
- Winkle A. Practice update: constipation in adults. Aust. J. Pharm. 2021;102(1202):67–72. Accessed October 4, 2023. https://search.informit.org/doi/10.3316/informit.671737265455820
- Schlichtemeier S, Engel A. Anal fissure. Aust Prescr. 2016 Feb;39(1):14-7. Accessed October 3, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816871/
- Navarro-Sánchez A, Luri-Prieto P, Compañ-Rosique A, Navarro-Ortiz R, Berenguer-Soler M, Gil-Guillén VF, et al. Sexuality, quality of life, anxiety, depression, and anger in patients with anal fissure: a case-control study. J. Clin. Med. 2021;10:4401. Accessed October 3, 2023. https://www.mdpi.com/2077-0383/10/19/4401