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Anal Fissure — Frequently Asked Questions

  • Prof. Dr. Zahid Mahmood
  • August 3, 2026

Anal Fissure — Frequently Asked Questions

Answered by Prof. Dr. Zahid Mahmood — General, Laparoscopic & Laser Surgeon, Lahore.

Why is an anal fissure so painful?

Because the tear triggers the internal muscle to spasm, which pulls on the tear and cuts off its blood supply. This keeps the fissure open and causes intense pain during and after passing stool. Relaxing the muscle relieves the pain and lets it heal.

Will an anal fissure heal on its own?

Many acute fissures heal with simple measures — softening the stool, warm sitz baths, and relaxing the muscle. Chronic fissures are less likely to heal alone and may need an ointment, injection, or procedure.

Does a fissure always need surgery?

No. The great majority heal with stool softening, sitz baths, and muscle-relaxing ointments. Only a minority — usually long-standing chronic fissures — need a procedure.

Is fissure surgery painful?

Most patients feel dramatic relief of the fissure pain very soon after a sphincterotomy or laser procedure. There is minor discomfort, well managed, and recovery is quick.

Is laser treatment better for fissures?

For suitable patients, laser offers a precise, gentle treatment with less pain and quick recovery. Whether it is best for you depends on your fissure and your continence risk, which your surgeon will assess.

Will the treatment affect my control over motions?

Ointments and Botox carry very little risk. A sphincterotomy carries a small risk, which is why muscle-sparing options are chosen for those at higher risk. Continence is protected in the great majority of patients.

What is a sitz bath and does it help?

Sitting in a few inches of warm water for about ten minutes, two or three times a day, relaxes the muscle, eases pain, and improves blood flow — one of the simplest and most effective measures for a fissure.

Is isabgol helpful?

Yes. Isabgol (psyllium husk) softens the stool so it no longer re-tears the fissure. It is cheap, widely available, and very effective for healing and preventing fissures.

Is a fissure the same as piles?

No. A fissure is a painful tear; piles are swollen blood vessels that mainly bleed. They are different conditions with different treatments, though they can occur together.

How long does a fissure take to heal?

Acute fissures often heal within a couple of weeks with good stool-softening and sitz baths. Chronic fissures take longer and may need ointments or a procedure; after surgery, relief is usually rapid.

Can a fissure come back?

It can, especially if constipation and straining continue. Keeping the stool soft with fibre and water is the best way to prevent recurrence.

Are the ointments safe?

Yes, the muscle-relaxing ointments (GTN, diltiazem) are safe when used as directed. GTN can cause headaches in some people; diltiazem usually has fewer side effects.

Can children get anal fissures?

Yes, they are common in infants and children, usually from constipation, and nearly always heal with stool softening and simple measures.

Can a fissure be a sign of something serious?

Usually it is an ordinary tear. But a fissure that is off to the side, atypical, or keeps recurring despite treatment can occasionally point to another condition such as Crohn’s disease or tuberculosis, which is why such fissures are assessed carefully.

When should I see a doctor?

If you have severe pain on passing stool, bleeding, or a fissure that does not heal within a couple of weeks of simple measures — or one that keeps coming back. Seek prompt care for heavy bleeding or signs of infection.

How do I book a consultation?

Call Prof. Dr. Zahid Mahmood on 0300 413 0159, or visit professorzahid.com.

This page is for general awareness and does not replace a personal medical consultation.

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