Anal fissure: symptoms, treatment and how long it takes to heal

If a fissure is not healing or is getting worse, the NHS lists laxatives for constipation, medicines for pain after a bowel movement such as Buscopan or mebeverine, and a cream applied to the anus to help healing, which may be needed for up to 8 weeks.

The NHS suggests taking paracetamol or ibuprofen for pain, drinking plenty of fluids and eating plenty of fibre to keep stools soft, soaking in a warm, shallow bath after a bowel movement, and keeping the area clean and dry. It advises against ignoring the urge to go. The NHS constipation advice adds practical steps: gradually increase fibre such as wheat bran, oats or linseed, drink plenty of water, keep to a regular toilet routine, rest your feet on a low stool so your knees are above your hips, and stay active.

A pharmacist can suggest a suitable laxative if diet changes are not enough. The NHS says most laxatives work within 3 days and should only be used for a short time.

The NHS lists severe, sharp pain when you pass a stool, burning pain afterwards that may last several hours, and bright red blood in the toilet or on the paper. It cautions that other conditions cause anal pain and rectal bleeding, such as piles (haemorrhoids).

The NHS piles guidance helps tell the two apart: piles may cause lumps around the anus, itching, mucus and a feeling of incomplete emptying, whereas a fissure is typically defined by pain with and after passing stool. Blood in the stool that is painless, persistent or accompanied by weight loss or a change in bowel habit should always be checked by a GP.

A fissure is a small split or tear in the lining at the opening of the back passage. The NHS says it is not always clear what causes one.

Fissures are more common in people aged 15 to 40 and in young children. They are often linked with passing hard stools, but a hard stool is not always the cause.

The NHS says an anal fissure usually heals on its own or gets better with simple measures, and that if it is not healing or symptoms are getting worse you may need treatment. It does not give a fixed healing time. It says to see a GP if symptoms are getting worse or there is no improvement after 7 days of treating it yourself.

If a healing cream is prescribed, the NHS says you may need to use it for up to 8 weeks. Fissures that keep coming back may be considered for a procedure.

The NHS says you may be more likely to get an anal fissure if you have any of the following.

• Constipation, which is a common cause of fissures in children.

• Frequent diarrhoea.

• Pregnancy, or a vaginal birth.

• Inflammatory bowel disease, Crohn's disease or ulcerative colitis.

• A sexually transmitted infection such as syphilis or herpes.

The NHS says anal fissures are more common in people aged 15 to 40 and in young children, and that constipation is a common cause of anal fissures in children. It advises seeing a GP if your child has symptoms of an anal fissure and they are getting worse or have not improved after 7 days of treating it yourself. The NHS also has separate advice on constipation in babies and children.

Being pregnant or having given birth vaginally makes a fissure more likely, according to the NHS. Its constipation advice says constipation is common during pregnancy and after giving birth, and that simple measures such as more fibre, fluids and regular activity are safe to try when pregnant. Speak to a pharmacist, midwife or GP before using laxatives or creams during pregnancy.

The NHS says to see a GP if symptoms get worse, or there is no improvement after 7 days of self-treatment. The GP asks about symptoms and looks at the anus. A referral for examination under general anaesthetic may be made if the GP is unsure of the diagnosis, if something serious may be causing it, or if the examination is too painful or provokes muscle spasm in the anus.

Fissures can come back, particularly when constipation recurs. Keeping stools soft with a fibre-rich diet, drinking enough and responding to the urge to go is the practical foundation. The NHS says constipation is more likely after changes in routine, as a medicine side effect or with stress, so reviewing any new tablets with a pharmacist or GP is worthwhile. People who keep getting fissures should discuss it with a GP because the NHS says procedures may be recommended for fissures that keep coming back.

Most fissures are managed by GPs or pharmacists. Persistent or recurrent fissures are referred to colorectal surgery. Private colorectal surgeons can offer faster assessment and the procedures above; ask what the procedure involves, the recovery, and what happens if the fissure returns.