Medically reviewed by

Dr. Carmen Fong

How to Heal an Anal Fissure

A fissure often starts with one awful bowel movement, then turns into a pattern. Sharp pain. Fear of going again. Tightening. More pain. By the time individuals search for how to heal anal fissure, they’re not looking for a definition. They want to know what works, what doesn’t, and when it’s time to stop waiting.

The good news is that many fissures do heal. The less helpful news is that they don’t heal by guesswork, or pushing through pain. The right plan focuses on two things at the same time: protecting the tear from repeated trauma and relaxing the anal sphincter enough to restore blood flow so the tissue can close.

We would recommend to seek treatment with Bummed as soon as possible. Bummed offers ingredients such as diltiazem, which is clinically proven to heal up to 75% of fissures.

What Is an Anal Fissure and Why Does It Hurt So Much

An anal fissure is a small tear in the lining of the anal canal. Small tear, big pain. That surprises people, but the tissue in this area is highly sensitive, and even a short split can cause sharp pain during a bowel movement and aching or spasm afterward.

The pain spasm blood flow cycle

The reason fissures linger is that they often get trapped in a cycle. The tear hurts, so the internal anal sphincter tightens. That spasm reduces blood flow to the injured tissue. Lower blood flow makes healing slower, so the next bowel movement reopens the tear and restarts the cycle.

This is why simple advice like “just use a cream” often falls short. Healing usually depends on reducing repeated trauma and relaxing the muscle enough for the area to recover.

It’s not always constipation

Constipation is a common trigger, but it isn’t the only one. Johns Hopkins notes that fissures can be caused or worsened by either constipation or chronic diarrhea, which is an important detail for people dealing with medication-related bowel changes, including GLP-1 use (Johns Hopkins Medicine on anal fissures).

That means the goal isn’t blindly adding bulk. The goal is normal stool consistency. For some people that means softer stool and less straining. For others, it means calming loose, frequent bowel movements that keep irritating the same spot.

Fissure or hemorrhoid

People often confuse fissures with hemorrhoids because both can cause bleeding and discomfort. The pattern of pain is usually the clue. Fissures tend to cause sharper pain during and after bowel movements. If you’re trying to sort out the difference, this guide on hemorrhoids versus anal fissures can help.

When spasm is a major part of the problem, broader pelvic floor tension can also matter. For a plain-language explanation of muscle over-tightening, these insights for NDIS pelvic spasm management are useful background.

Your First-Line Healing Plan at Home

For an acute fissure, home care isn’t “doing nothing.” It’s the standard first move, and it works for many people when done consistently. The American Society of Colon and Rectal Surgeons and Mayo Clinic recommend warm baths for 10 to 20 minutes several times daily and 25 to 35 g/day of fiber, and ASCRS notes that nearly half of acute fissures can resolve with nonoperative care (ASCRS management guidance).

Start with stool consistency

Think less about “going more” and more about “going gently.” You want stool that passes without stretching or scraping the tear.

A practical home plan looks like this:

1. Increase fiber intake to the recommended daily range. Food first is fine, and a fiber supplement can help if your diet is inconsistent.

2. Drink enough fluid to keep stool soft. Fiber without enough fluid can backfire.

3. Don’t strain and don’t sit on the toilet longer than necessary.

4. Respond to the urge to go instead of repeatedly delaying bowel movements.

Know when fiber is the wrong main tool

Fiber helps many fissures. It does not fix every constipation pattern.

If stool is dry, rabbit-pellet hard, or difficult to move even with decent fiber intake, an osmotic laxative is often more useful than adding more bulk. Osmotic agents pull water into the stool. In practice, that often reduces re-injury more effectively than another spoonful of fiber powder.

Here is the trade-off:

If you are trying to decide between these options, this guide to choosing a stool softener for anal fissure care can help you compare them in plain language.

Use warmth to relax the muscle

Warm sitz baths help because they relax the anal sphincter and reduce discomfort. Mayo Clinic recommends warm-water baths for 10 to 20 minutes several times daily, especially after bowel movements, as summarized in the ASCRS guidance above.

You don’t need anything fancy. A bathtub, a sitz bath basin, or warm water in the shower can all work if the water is comfortable and the routine is consistent.

For technique and setup, this overview of sitz bath benefits is a practical place to start.

Protect the area and avoid common mistakes

Home care works best when you remove the habits that keep reopening the fissure.

A few high-yield adjustments:

• Use gentle hygiene: Pat instead of wiping aggressively. Fragrance-free cleansing is less irritating than repeated dry friction. We also recommend to avoid using wipes, which can often be quite harsh.

• Consider a simple barrier ointment: This can reduce surface irritation, especially if the area is raw.

• Use a topical anesthetic carefully: It can make bowel movements less intimidating when pain is causing avoidance. These are available through Bummed, after a consult with a licensed medical provider.

• Skip “random OTC rotation”: Switching between products every day usually adds irritation and confusion.

What doesn’t work well is chasing instant relief while ignoring the trigger. If constipation, straining, or loose stools continue, the fissure keeps getting hit before it has time to close.

When Home Care Is Not Enough Prescription Treatments That Work

When pain persists, bowel movements are still dreaded, or the fissure keeps reopening, it’s time to think beyond home remedies. This is the point many guides gloss over. They list fiber and baths, then stop. In actual practice, the next step is usually a prescription treatment that relaxes the internal sphincter and improves blood flow to the tear.

What prescription treatment is trying to do

A fissure that isn’t settling down often needs more than stool softening. It needs targeted muscle relaxation. That’s why commonly used prescription options include topical nitrates and calcium-channel blockers. They’re used to reduce sphincter pressure so the tissue can get better blood flow and finally heal.

One evidence-based option is topical diltiazem. In a clinical study, 2% diltiazem gel completely healed 75% of anal fissures by significantly reducing resting anal muscle pressure (British Journal of Surgery study on topical diltiazem).

Diltiazem is found in Bummed’s best-selling Long-Acting Hemorrhoid and Fissure Rx Cream.

Why diltiazem makes sense

Diltiazem is a calcium-channel blocker. In plain language, it helps the tight internal sphincter relax. Less pressure means less pain with bowel movements and better blood flow to the tear.

That mechanism matters because many stubborn fissures are not failing from lack of ointment. They’re failing because the muscle remains too tight for the tissue to recover.

When a fissure keeps recurring, the missing ingredient is often sphincter relaxation, not more wiping, more supplements, or more waiting.

A practical telehealth option

For adults who want a private, straightforward next step, Bummed’s Long Acting Hemorrhoid & Fissure Rx Cream is one prescription option available through Bummed. It includes diltiazem, which is used to relax the anal sphincter and support healing by improving blood flow to the fissure. It’s also generally considered pregnancy safe, though it’s still important to check with your own provider before starting any new medication.

That kind of option can make sense when you’re caught in the middle ground. Too symptomatic to rely on home care alone, but not yet at the point of needing a procedure.

Another prescription often used for fissures is Nitroglycerin, which can be found in Bummed’s Rapid Relief Hemorrhoid & Fissure Rx Cream. One of the most referenced clinical trials on nitroglycerin, published in Diseases of the Colon & Rectum, documented how patients using a nitroglycerin ointment experienced dramatic reductions in pain and saw their fissures heal significantly faster. You can read a summary of that research here in this study on nitroglycerin for anal fissures. Some patients do report side effects, such as headaches, with nitroglycerin. A gentler option is nifedipine, found in Bummed’s Sensitive Care Hemorrhoid & Fissure Rx Cream. Bummed’s medical providers will be able to guide you to the most appropriate treatment plan for you.

In a cohort of 623 patients with acute anal fissure managed conservatively, the fissure healed completely in 70.5%, and another 18.0% healed with an epithelialized scar. The median time to being free of symptoms was 11 weeks, and recurrence still occurred in 28.9% overall (study of conservative management outcomes). That’s why early home care matters, but patience matters too.

When to stop trying the same home routine

The key question isn’t whether a bath helps for an hour. It’s whether the fissure is moving toward closure. If pain remains severe, bleeding continues, or bowel movements still trigger the same tearing sensation week after week, home care may no longer be enough.

This is also where confusion about Botox often comes up. Some people hear it mentioned and assume it’s cosmetic or unrelated. It isn’t. Botulinum toxin can relax overactive muscles, and this plain-language article on understanding Botox for pain gives helpful context for how that principle applies more broadly.

Where chronic fissure data becomes important

Once a fissure becomes chronic, treatment selection matters much more. According to StatPearls, lateral internal sphincterotomy has durable healing in more than 90% of cases, and some studies report about 96% complete resolution within 3 weeks (StatPearls review of anal fissure treatment). An independent meta-analysis of over 1,000 patients found a 3.7% recurrence rate after the procedure.

For botulinum toxin (otherwise known as botox injections), a 5-year outcomes study of 199 patients found 87.4% healing at 2 months after the first injection, with 73.8% maintaining complete healing at 5 years after up to two injections, and 26.2% ultimately requiring surgery (5-year botulinum toxin outcomes study).

If you want a closer look at one of the most commonly used topical options, this overview of diltiazem for anorectal pain and fissures explains why it’s often chosen before procedural treatment.

If you take a GLP-1 medication

This gets missed often. Medications such as semaglutide can slow digestion and change appetite, which can lead to less food intake, less fluid intake, and harder stool. For some patients, the fissure started after the medication change, not before it.

Treat that constipation early. Do not wait until you have had several painful bowel movements in a row. In this setting, hydration and stool-softening support are often more useful than trying to solve the problem with fiber alone.

Consider pelvic floor dysfunction when the usual advice is not enough

Some fissures stay chronic even when stool is soft and the person is doing the standard things correctly. One common reason is pelvic floor dysfunction. The muscles at the outlet do not relax well, so bowel movements feel blocked or incomplete even when the stool itself is not hard.

That pattern matters because more fiber will not fix a muscle that stays clenched. The American Society of Colon and Rectal Surgeons patient information on anal fissure notes that ongoing sphincter spasm plays a major role in pain and healing problems. If you feel persistent outlet tightness, incomplete emptying, or the need to strain despite soft stool, ask whether pelvic floor physical therapy should be part of your plan.

Some people also ask about soothing products for the surrounding skin.

The Escalation Pathway Specialist Procedures

The biggest decision point is timing. Clinical guidance generally recommends about a 6-week trial of conservative therapy, and if that fails, the next steps are medical therapies such as calcium-channel blockers or specialist procedures. If you are in pain, we would recommend you move from home care to prescription treatment for faster healing.

Botulinum toxin injection

Botulinum toxin, often called Botox, is used to temporarily relax the internal sphincter. The goal is straightforward: lower pressure long enough for the fissure to heal. This can be a reasonable step for people who haven’t responded to home care and prescriptions, or for those trying to avoid surgery.

The trade-off is that the effect is temporary. Some fissures heal during that window. Others improve but recur.

Lateral internal sphincterotomy

Lateral internal sphincterotomy, often shortened to LIS, is the standard surgical option for fissures that remain refractory. It works by partially dividing the internal sphincter to reduce the high resting pressure that keeps the fissure open.

For the right patient, this can be very effective. But it isn’t a casual decision.

If you’ve already tried the basics and a prescription approach without meaningful progress, a colorectal specialist can help decide whether continued medical therapy or a procedure makes more sense.

Managing Pain and Preventing Recurrence

Healing the current fissure is only half the job. The other half is preventing the same cycle from restarting. Most acute fissures heal within a few weeks to six weeks with conservative care such as stool softeners, fiber, and sitz baths, and fissures that persist beyond that point are considered chronic and are less likely to heal without medical treatment, as summarized by Cleveland Clinic and Johns Hopkins (Cleveland Clinic overview of anal fissures).

What helps pain while you heal

Pain control should make bowel movements easier, not mask ongoing trauma.

Useful measures include:

• Warm sitz baths after bowel movements: They reduce spasm and often shorten the pain flare afterward.

• Topical anesthetic when appropriate: This can help if pain is making you avoid going. Bummed includes both lidocaine and bupivacaine in its formulations for instant and longer-term pain relief. Bupivacaine is a non-opioid local anesthetic, meaning it temporarily blocks nerve signals in a specific area. It’s commonly used in hospitals and surgical settings because it provides prolonged numbing—think hours, not minutes.

• Gentle bowel habits: No straining, no repeated wiping, no long toilet sessions with your phone.

If constipation is part of the pattern, improving transit matters too. This guide on how to improve gut motility can help you think through the bigger picture.

How to keep it from coming back

Recurrence prevention is mostly unglamorous consistency. Keep the stool soft enough to pass easily. Avoid the bowel movement that feels like “tearing paper.” Don’t swing from constipation to overcorrection and diarrhea if you can help it.

The habits that protect healing are simple:

• Stay consistent with fiber and fluids: Not just when symptoms flare.

• Go when your body signals: Delaying bowel movements often leads to harder stool.

• Keep hygiene gentle: Friction can keep the area irritated even after the tear is trying to close.

• Watch medication effects: If a medication changes your bowel pattern, adjust early instead of waiting for repeated trauma.

Warning signs that need prompt medical attention

Some symptoms deserve faster evaluation.

Seek urgent medical care if you have:

• Heavy bleeding

• Fever

• Rapidly worsening pain

• New drainage, marked swelling, or concern for infection

• Pain so severe you can’t pass stool or urine normally

Those problems can mean something more than a straightforward fissure, or a fissure with a complication.

Frequently Asked Questions About Healing Anal Fissures

Can an anal fissure heal on its own without treatment?

Yes, many acute fissures can heal without a procedure. Softening stool, staying hydrated, avoiding straining, and using warm sitz baths all improve the odds that the tear will close. What usually fails is waiting while the same bowel habit keeps reopening the fissure. Bummed’s prescription compounded creams are specifically formulated to help heal fissures, and include clinically-backed ingredients like Diltiazem or Nitroglycerin.

How do I know if I have an anal fissure or a hemorrhoid?

The symptom pattern helps. A fissure usually causes sharp pain during a bowel movement and lingering pain or spasm afterward. Hemorrhoids can bleed and cause discomfort, but they often don’t cause that same tearing pain pattern. If you’re unsure, a provider can usually sort this out with a focused history and exam. Bummed providers are specifically trained to help patients sort through their particular symptoms.

Is it safe to use Bummed’s prescription creams during pregnancy?

Some fissure treatments, including diltiazem-based topical treatment, are generally considered pregnancy safe. Even so, we always advise checking with your own medical provider before starting a new medication, because your medical history, trimester, symptoms, and other medications all matter.

What if my fissure is caused by diarrhea instead of constipation?

That changes the strategy. You still want to reduce trauma and relax the sphincter, but the priority becomes normalizing loose, frequent stools rather than adding more fiber without a plan. If diarrhea, medication side effects, or alternating bowel habits are driving the problem, treatment should focus on stool consistency overall.

When should we ask about pelvic floor therapy?

Ask when the fissure keeps returning despite softer stool and appropriate treatment, or when bowel movements feel blocked even though the stool is not especially hard. I also think about pelvic floor dysfunction when someone spends a long time on the toilet, strains without much output, or feels like the muscles will not let go.

That pattern matters. If the pelvic floor is not coordinating well, the fissure may keep getting re-injured even when the diet looks good on paper.

Bummed content is for general education and should never replace professional medical advice that considers your individual health. If you think you’re experiencing a medical emergency, call 911 or head to the nearest emergency department.

Prescription products require an online consultation with a physician who will determine if a prescription is appropriate.

If home care hasn’t been enough and you want a private, evidence-based next step, Bummed offers online evaluation for anal fissure treatment with board-certified provider review and prescription options if appropriate.