Anal Fissure

Anal Fissures: Causes, Symptoms, and the Most Effective Treatments
Specialist Guide by Dr. Rodney Kratz, Colon & Rectal Surgeon – Precision Proctology

Anal fissures are one of the most common causes of sharp anal pain and bleeding, yet they are often mistaken for hemorrhoids. If you’re experiencing pain during bowel movements, burning afterward, or bright red blood on the tissue, you may have an anal fissure — a condition that is highly treatable when diagnosed correctly.

 
What Is an Anal Fissure?
An anal fissure is a small tear in the lining of the anus. It can occur after:

Hard or large bowel movements
Constipation
Diarrhea
Straining
Childbirth
Anal trauma
Although the tear is small, it triggers spasm of the internal anal sphincter, which reduces blood flow and prevents healing. This “spasm cycle” is the reason fissures cause such severe, sharp pain.

 
What Are the Symptoms of an Anal Fissure?
Key symptoms include:
Knife-like pain with bowel movements
Bright red bleeding
Burning or throbbing pain that lasts minutes to hours
Fear of having a bowel movement
A visible or palpable skin tag (“sentinel pile”)
These symptoms are frequently confused with hemorrhoids, but the pain pattern is a major clue that the issue is a fissure.

 
Anal Fissure vs Hemorrhoid: What’s the Difference?
Many patients google “hemorrhoid pain” when they’re actually experiencing a fissure.

Here’s the distinction:

Most Common Symptoms
Pain Level-severe
Anal Fissure
Sharp pain, bleeding, burning, sphincter spasm

Hemorrhoids
Pressure, bulging/prolapse, itching, bleeding
Usually mild–moderate
A quick evaluation by a colon & rectal specialist can determine the correct diagnosis.

 
What Causes Anal Fissures Not to Heal?
Anal fissures become chronic when:

Constipation continues
The sphincter remains in spasm
Scar tissue forms
Blood flow is reduced
Inflammation persists
Many chronic fissures won’t heal without targeted medical therapy or office-based procedures.

 
How Are Anal Fissures Treated?
At Precision Proctology, I use a stepwise, proven treatment protocol designed to break the spasm cycle and restore normal healing.

1. Non-surgical Treatment
Best for acute fissures:

Stool softeners
Fiber optimization
Hydration
Sitz baths
Gentle hygiene techniques
These promote healing by softening stool and reducing trauma.

 
2. Prescription Medications for Anal Fissures
Chronic fissures often require medical therapy, including:

Topical calcium channel blockers
Nitroglycerin ointments
Compounded medications to relax the internal sphincter
Pain-reducing topical agents
These medications increase blood flow and reduce sphincter tightness, speeding healing.

 
3. Botox Injection for Chronic Anal Fissures
Botulinum toxin (Botox) temporarily relaxes the sphincter and interrupts the spasm cycle.
This is an excellent, non-surgical option for many patients and has high healing rates.

 
4. Surgical Treatment Option
Surgery is reserved for fissures that fail medical therapy or are severely chronic.

Lateral internal sphincterotomy (LIS) with Fissurectomy

The gold standard for chronic fissures
High healing rates and long-term success

Cuitting a small portion of the internal sphincter

Removal of scar tissue to promote healthy healing

Combined procedures for patients with fissures plus hemorrhoids or skin tags

My surgical approach prioritizes pain relief and continence preservation.

 
How Long Does It Take an Anal Fissure to Heal?
Acute fissures: often heal in 1–4 weeks
Chronic fissures: may require prescription therapy or interventions
After Botox: many heal within 6–12 weeks
After LIS surgery: high success rates with rapid symptom improvement
Healing time varies based on severity, bowel habits, and underlying anatomy.

 
When Should You See a Specialist?
Seek medical evaluation if:

You’ve had pain for more than 4–6 weeks
You experience severe or worsening pain
You’re unsure whether it’s a fissure or hemorrhoids
There is persistent bright red bleeding
You’ve already tried conservative care without improvement
Early treatment prevents fissures from becoming chronic and avoids unnecessary suffering.

 
Why Patients in Seattle, Edmonds, and Mountlake Terrace Choose Precision Proctology
Board-certified Colon & Rectal Surgeon with decades of experience
Expertise in fissures, hemorrhoids, abscesses, and fistulas
Private, discreet specialty practice
Same-day treatment plans
Precise diagnosis (no guessing or mislabeling hemorrhoids)
Follow-up focused on full healing and long-term prevention
My goal is simple: help you heal quickly and reduce the chance of recurrence.

 
How to Prevent Anal Fissures From Returning
Maintain soft, regular bowel movements
Avoid excessive straining
Stay hydrated
Increase dietary fiber or take a supplement
Treat constipation early
Protect the area from trauma or irritation
Preventive strategy is always part of your treatment plan.

 
Schedule an Evaluation for Anal Fissure Treatment
If you’re suffering from sharp anal pain or bleeding, you don’t need to wait for it to “go away.”
With the right specialist, fissures are highly treatable.

Precision Proctology
6808 220th St SW, Suite 200
Mountlake Terrace, WA 98043
Call: 425-515-0276