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Anal Fissures

What is an Anal Fissure?

An anal fissure is a small painful tear in the skin that lines the anus.


Similar to hemorrhoids, an anal fissure can occur while passing dry, hard or large stools, during constipation or prolonged straining of the bowel, during chronic diarrhea, or during childbirth. Anal intercourse may also cause anal fissures. We have cured thousands of patients with anal fissures without surgery. They are frequently misdiagnosed and inadequately treated with topical steroids. Many of these patients had been told by other physicians they would have to have surgery.

How do I Know if I Have a Fissure?

Fissures are most commonly located in the posterior position on the tail bone side of the anus. There may be an associated tag referred to as a sentinel pile. Symptoms of anal fissures include pain during bowel movement, pain after bowel movement lasting up to several hours, and bleeding. There may be a visible crack and an associated skin tag referred to as a sentinel pile. The pain can be sharp and severe, often described as similar to passing glass. Infants may be prone to anal fissures, as well as women who have just given birth, or those suffering from Crohn’s Disease. Anal fissures also occur in the aging and elderly.


Self-help measures include warm water baths, stool softeners, and lubrication. Fissures are frequently associated with internal hemorrhoids. The combination of hemorrhoids and fissures can be very painful. Our treatment can lead to very rapid improvement. We are frequently told it is a “miracle”.

The internal sphincter is a smooth muscle similar to the heart. The internal sphincter aids in continence. It lies under the fissure and in response to irritation goes into spasm leading to severe pain. In the past doctor’s frequently recommended surgery for fissures. This is not necessary and may lead to incontinence. We have found most fissures respond to our non-operative treatment. Do not agree to a possible unnecessary operation until you have tried our non-surgical office treatment.

Relaxation of the internal sphincter allows for the fissure to heal. Your doctor may recommend topical medications (smooth muscle relaxers) that relax smooth muscle. Muscle relaxation injections may be occasionally injected for difficult cases. These types of fissures treatments lower the pressure of the rectal muscle, making it easier for the fissure to heal.

Under normal conditions, anal fissures are treated with topical smooth muscle relaxer ointment, stool softeners, and tub baths. The ligation of associated hemorrhoids also lowers the rectal pressure which aides in the healing of the fissure. The ointment is continued for at least 8 weeks to prevent recurrence of the fissure. Our doctors have high quality custom compound ointments that they can prescribe.

As the body tries to heal the fissure it may form a lump in the skin around the outside of the fissure, a sentinel pile. These tags may be excised, which can be done under local anesthesia in the office.

In the rarest and most severe cases of anal fissures, surgery that involves cutting the underlying muscle may be required. This operation is called an internal sphincterotomy. It is done in an operating room under anesthesia. Patient should be aware there is a slight chance of incontinence with surgery, but this usually improves with time.

Our anal fissure treatment with custom topical compounds, stool softeners, sitz baths, and ligation of enlarged hemorrhoids is very successful. This combination therapy will heal almost all fissures.

At HCA we only use disposable ligation systems. Dr. Goldman introduced disposable banding to the Southeastern United States in 2006. Dr. Alan Goldman is the Medical Director of Hemorrhoid Centers of America. At HCA we have helped thousands of patients avoid surgery and get the relief they deserve. We will start you on our special hemorrhoid compounds as needed for immediate relief and help you get rid of your hemorrhoids with our ligation system.

About 1 in 20 Americans have hemorrhoids. You are not alone.

Dr. Alan Goldman

Visit one of our doctors. We're looking forward to help you find the relief you deserve