If going to the bathroom suddenly feels painful, or becomes something you start to dread, it could be more than a one-time issue.
One possible cause is an anal fissure — a small tear in the lining of the anal canal.
“It might be tiny, but because the area is so sensitive, it can be incredibly uncomfortable,” says Joseph Soucy, MD, a gastroenterologist with PACT Gastroenterology Center and Hartford HealthCare’s Digestive Health Institute. “It often starts with a bowel movement – and patients describe it as feeling like passing shards of glass – and that pain can linger afterward.”
The good news is that most anal fissures can heal with the right treatment. Here’s what to know, and how you can find relief.
What causes an anal fissure
Most anal fissures happen when the anal canal stretches more than it should.
This can happen with:
- Constipation or hard, dry stool
- Frequent or loose bowel movements
- Straining during bowel movements
- A naturally tight anal opening
And while some fissures heal quickly, others can stick around.
“While most fissures are acute and short-term, some can become chronic,” explains Dr. Soucy. “If they last longer than 6 to 8 weeks, they may need more advanced treatment.”
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Why something so small can hurt so much
A tiny tear might not sound like a big deal. But in this part of the body, it can be very painful.
Inside the anal canal is a muscle called the internal sphincter. When a fissure forms, that muscle often tightens in response.
That spasm can:
- Increase pain
- Reduce blood flow to the area
- Slow the healing process
In other words, the pain can set off a cycle: the muscle tightens, the fissure gets less blood flow and healing becomes harder.
“Relaxing that muscle is key,” says Dr. Soucy. “That’s why many treatments focus on reducing spasms and improving blood flow.”
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The symptoms are usually hard to miss
Anal fissures tend to cause very specific symptoms, especially during or after a bowel movement.
You may notice:
- Sharp pain during bowel movements
- Pain that lasts minutes, or even hours afterward
- Bright red blood on toilet paper or stool
- A small tear or lump near the anal opening
“Unlike hemorrhoids, fissures typically cause sharp pain during bowel movements, while hemorrhoids more often cause painless bleeding or pressure,” says Dr. Soucy.
> Related: 8 Reasons Why There Might Be Blood in Your Stool
How to help an anal fissure heal
The main goal is simple: Make bowel movements softer and easier to pass, so the tear has time to heal.
Treatment usually starts at home with:
- Adding more fiber to your diet or using a supplement like Metamucil
- Drinking plenty of fluids – about 64 ounces a day
- Using stool softeners if needed
- Taking warm sitz baths to relax the area
Prescription creams, such as nitroglycerin or calcium channel blockers, may also help. These work by relaxing the muscle and improving blood flow, which can support healing.
“If these steps aren’t enough, we can talk about other options like Botox injections to relax the sphincter muscle,” says Dr. Soucy. “For chronic fissures that don’t respond to treatment, a minor surgical procedure can provide lasting relief.”
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When to see your doctor
Preventing constipation and avoiding straining are two of the best ways to lower your risk of anal fissures.
But if symptoms have already started, don’t wait too long to get help.
Check in with your doctor if:
- Pain is severe or not improving
- Bleeding continues
- Symptoms last more than a few weeks
- You’re unsure what’s causing the pain or bleeding
“Not all rectal pain or bleeding is a fissure – other conditions can look similar,” says Dr. Soucy. “We can usually diagnose it quickly with an office exam and help patients start healing right away.”
