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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. A typical fissure is recognised from your symptoms and treated by video; one that does not heal, or may have another cause, needs an examination in person.
- What it is: a small tear in the lining of the anus, usually caused by passing a large or hard poo.
- Main symptoms: severe, sharp pain when you poo, a burning pain that can last for hours afterwards, and bright red blood on the toilet paper.
- How long it lasts: most heal within a few days to a few weeks; one that lasts more than 6 to 8 weeks is called chronic.
- Emergency: call 112 for bleeding from the bottom that will not stop, a lot of blood or large clots, or black, tar-like poo.
An anal fissure is rarely an emergency. Do not book a video appointment if you are bleeding non-stop from the bottom, passing a lot of blood or large clots, or have black, tar-like poo: call 112 or go to an emergency department. A high temperature with a painful, swollen bottom or pus needs prompt in-person care.
Can an online doctor treat an anal fissure?
Yes. A typical anal fissure is recognised from your symptoms, sharp pain when you poo and bright red blood, and a doctor can assess it by video, ease the pain, help soften your poo and prescribe an ointment that helps the tear heal. You choose what you show on camera. A fissure that has not healed after treatment, one that keeps coming back, or symptoms that suggest another cause need an examination in person, and injections and surgery are done in hospital.
How an online consultation helps with an anal fissure
- Fissure or piles?: Sharp pain during and after a poo points to a fissure; a lump and painless bleeding point to piles.
- Pain relief that works: Warm baths, the right painkiller and, for a short time, an anaesthetic ointment.
- An ointment that helps it heal: Prescription ointments relax the muscle around the anus so the tear can heal.
- Stopping it coming back: Softer poo with fibre, fluids and the right laxative, and a plan if it does not heal.
What the doctor checks in an online anal fissure consultation
The doctor asks about the warning signs first, then about the fissure itself. The doctor asks about:
- Warning signs: heavy bleeding, black or dark red poo, a high temperature with swelling or pus, weight loss, or a lasting change in bowel habit.
- The pain: whether it is sharp during a poo, how long the burning lasts afterwards, and whether it is getting better.
- The bleeding: bright red blood on the paper or in the pan, and how much.
- Your bowels: constipation, hard poo, straining, or diarrhoea.
- How long: when it started, and whether you have had a fissure before.
- Your health: pregnancy or a recent birth, Crohn’s disease or colitis, and the medicines you take.
Before the call, find a private space. You choose what you show on camera, and the doctor tells you if an examination in person would help.
What is an anal fissure, and what does it feel like?
An anal fissure is a small tear or crack in the lining of the anus, the opening at the end of the bowel. It is common, and it usually gets better on its own. The symptoms are:
- severe, sharp pain when you poo
- a burning pain afterwards that can last for several hours
- bright red blood in the toilet or on the toilet paper
- burning or itching around the anus
- sometimes spasms of the muscle around the anus
What does an anal fissure look like?
A small crack in the skin at the edge of the anus, or just inside it, so it is not always visible. Sometimes there is a small lump or skin tag next to it.
Anal fissure or piles: how do you tell the difference?
Both cause bright red blood after a poo, but the pain is different. A fissure hurts sharply during a poo and burns for hours afterwards; piles are usually painless unless a clot forms.
Swipe sideways to compare →
| What you notice | Anal fissure | Piles |
|---|---|---|
| Pain | Severe and sharp during a poo, then burning for hours | Often none; discomfort or itching; severe only with a clot |
| Bleeding | Bright red, on the paper or in the toilet | Bright red, on the paper or in the toilet |
| Lump | Sometimes a small skin tag | Soft lumps around the anus, or one that comes out after a poo |
| Itching | Sometimes, with burning | Common |
| Main cause | A large or hard poo tearing the lining | Swollen blood vessels, from straining and pressure |
| Treated online? | Yes, usually | Yes, usually |
The piles page covers them in detail, and itching on its own is covered on the anal itching page.
What causes an anal fissure, and who gets one?
Most fissures are caused by passing a large or hard poo, which tears the lining of the anus. The cause is not always clear. These make a fissure more likely:
- constipation and straining
- diarrhoea that keeps coming back
- pregnancy, and giving birth
- anal sex
- Crohn’s disease, ulcerative colitis or another inflammatory bowel disease
- less often, infections such as syphilis or herpes, HIV, tuberculosis, or anal cancer
Fissures can happen at any age, but they are most common between 15 and 40, and about half of people with a fissure get it before they turn 40. They are also common in young children and in pregnancy.
Why some fissures do not heal
The ring of muscle around the anus can go into spasm and stay tight. That reduces the blood supply to the lining, which slows healing, and the pain of each poo makes the spasm worse. Breaking this cycle, by softening the poo and relaxing the muscle, is the aim of treatment.
How long does an anal fissure take to heal?
Most fissures heal within a few days to a few weeks, often in 1 to 2 weeks, once the poo is soft. See a doctor if there is no improvement after 7 days of self-care. A fissure that lasts more than 6 weeks, or 8 weeks in some guidance, is called chronic, and treatment can then take another 6 to 12 weeks to work.
What happens if a fissure is left untreated?
Many heal on their own, but a fissure that does not can become a persistent wound, kept open by the cycle of pain, muscle spasm and poor blood flow. It can extend into the muscle around the anus, and complications include hard poo stuck in the bowel, a narrowing of the anus, and an anal fistula, a small tunnel to the skin.
Is an anal fissure serious?
Usually not: it is painful, but most heal fully. Once you have had one, you are more likely to get another. Bleeding is sometimes a sign of something else, including bowel cancer, so blood in your poo for 3 weeks, or bleeding with a change in bowel habit or weight loss, needs a doctor.
How do you heal an anal fissure fast?
Keep your poo soft and avoid straining, ease the pain, and, if it is not healing, use a prescription ointment that relaxes the muscle. For a fissure that does not heal, these are the options, with how well they work:
Swipe sideways to compare →
| Treatment | How it works | How well it works | Main downsides |
|---|---|---|---|
| Glyceryl trinitrate ointment, for 6 to 8 weeks | Relaxes the muscle and improves blood flow | About 7 in 10 chronic fissures heal, compared with about 5 in 10 with standard care | Headaches in up to 6 in 10 people, usually passing within half an hour |
| Diltiazem ointment | Relaxes the muscle | A similar effect; an option if glyceryl trinitrate does not work or causes headaches | Itching, which usually settles after a few days |
| Botulinum toxin injection | Relaxes the muscle for about 3 months | About 7 in 10 heal | Occasional minor loss of control of wind; given in hospital, usually under general anaesthetic |
| Lateral sphincterotomy (surgery) | A small cut in the muscle reduces the tension | At least 9 in 10 heal | Up to 1 in 3 have poorer control of wind; a few have soiling |
Can an anal fissure be cured permanently?
Most fissures heal completely. Up to 3 in 10 people successfully treated with glyceryl trinitrate ointment get another fissure later, which can be treated with a further course. For fissures that keep coming back or do not heal, surgery cures at least 9 in 10, but with some risk to the control of wind.
Which anal fissure treatment might the doctor recommend?
Treatment depends on how long the fissure has been there and whether it is healing. This is the framework the doctors use:
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| A new fissure with pain and a little bleeding | Fibre, fluids, a laxative, warm baths and paracetamol | Yes | Not usually needed |
| Severe pain after every poo | A short course of anaesthetic ointment as well | Yes | Not usually needed |
| No better after a week of self-care | A prescription ointment that relaxes the muscle, for 6 to 8 weeks | Yes | If it has not healed after the course |
| A fissure lasting more than 6 to 8 weeks, or one that keeps coming back | Referral for an injection or surgery | Partly | For the examination and the procedure |
| A fissure with diarrhoea, weight loss or a lasting change in bowel habit | Tests for another cause, such as Crohn’s disease | Partly | For the examination and tests |
| Non-stop or heavy bleeding, large clots, or black poo | Emergency care | No | Call 112 now |
Sharp pain every time you poo? A doctor can tell you in one consultation what will help it heal.
See available times →Treatment options for an anal fissure
What you can do yourself
- Drink plenty of fluids and eat plenty of fibre to keep your poo soft. A bulk-forming fibre supplement can help.
- Go when you feel the urge, and do not strain. Resting your feet on a low stool can help.
- Have a warm, shallow bath after you poo, two or three times a day, for at least 10 minutes.
- Take paracetamol or ibuprofen for the pain, and avoid painkillers containing codeine, which cause constipation.
- Keep the area clean and dry, and wash gently.
Prescription treatment
A prescription is never issued without a consultation. If the fissure is not healing, the doctor may prescribe an ointment that relaxes the muscle around the anus, such as glyceryl trinitrate or diltiazem. The course lasts 6 to 8 weeks, and it is important to finish it even after the pain eases. The doctor may also recommend a local anaesthetic ointment for a short time, and a laxative or stool softener, after checking your other medicines. Painkillers containing codeine make constipation worse and are never prescribed online. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Codeine painkillers, which cause constipation. Ignoring the urge to poo, or straining. Using an anaesthetic ointment for long periods. Stopping a prescribed ointment as soon as the pain eases, before the course is finished.
Special situations
Pregnancy and after giving birth
Fissures are common in pregnancy and after a vaginal birth. Tell the doctor if you are pregnant or breastfeeding, because it changes which ointments and laxatives are suitable. Constipation in pregnancy is covered on the constipation in pregnancy page.
Crohn’s disease or colitis
Inflammatory bowel disease makes the lining of the anus more prone to tearing. Tell the doctor, because the plan may involve your specialist; see Crohn’s disease.
Anal fissures while travelling in Europe
A change of diet and routine, and not drinking enough in hot weather, can bring on constipation, and repeated diarrhoea can cause a fissure too. Keep up fluids and fibre, and see the travellers’ diarrhoea page if your bowels go the other way.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When an anal fissure is treated online, and when you need in-person care
Treated online: a new or typical fissure, pain relief, softening the poo, prescription ointments, and reviews while the fissure heals.
In-person care: a fissure that has not healed after treatment or keeps coming back, symptoms that suggest another cause, botulinum toxin injections and surgery, and any heavy bleeding.
When to get in-person care
Call 112 or go to an emergency department now for:
- bleeding from the bottom that will not stop
- a lot of blood, such as the toilet water turning red, or large blood clots
- black, tar-like poo, or vomiting blood
Get medical advice the same day for:
- a high temperature, or feeling hot and shivery, with pain and swelling around your bottom
- pus leaking from around your bottom
- dark red poo, or bloody diarrhoea
- pain or bleeding that is getting worse despite treatment
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your symptoms: describe the pain and the bleeding, say how long it has lasted and how your bowels have been, and list what you have tried.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s an anal fissure? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Piles (haemorrhoids) can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about anal fissures
What is an anal fissure?
An anal fissure is a small tear or crack in the lining of the anus, usually caused by passing a large or hard poo. It causes sharp pain when you poo and bright red blood, and usually heals on its own.
What does an anal fissure feel like?
An anal fissure causes a severe, sharp pain when you poo, followed by a burning pain that can last for several hours. Some people also have itching, burning or spasms of the muscle around the anus.
What does an anal fissure look like?
An anal fissure is a small crack in the skin at the edge of the anus or just inside it, so it is not always visible. Sometimes there is a small lump or skin tag next to it.
How do I know if I have piles or a fissure?
A fissure causes sharp pain during a poo and burning afterwards. Piles are usually painless, with a soft lump, itching or bleeding. Both cause bright red blood, and a doctor can tell them apart.
How do you heal an anal fissure fast at home?
To heal an anal fissure fast, keep your poo soft with fibre and fluids, do not strain, have warm, shallow baths after a poo, and take paracetamol or ibuprofen. If it is not improving after a week, a doctor can prescribe an ointment that relaxes the muscle and helps it heal.
How long does an anal fissure take to heal?
Most heal within a few days to a few weeks, often in 1 to 2 weeks. A fissure lasting more than 6 to 8 weeks is called chronic, and treatment can take another 6 to 12 weeks to work.
What happens if a fissure is left untreated?
Many fissures heal on their own, but some become a persistent wound kept open by muscle spasm and poor blood flow. Complications include a narrowing of the anus and an anal fistula.
Is an anal fissure serious?
Usually not. An anal fissure can be very painful, but most heal fully. Bleeding that lasts 3 weeks, or comes with a change in bowel habit or weight loss, needs a doctor to rule out other causes.
Can an anal fissure be cured permanently?
Most heal completely. Fissures can come back, in up to 3 in 10 people after successful ointment treatment. For fissures that keep returning, surgery cures at least 9 in 10, with some risk to the control of wind.
How can I prevent an anal fissure coming back?
Keep your poo soft and regular: eat 25 to 30 g of fibre a day drink enough water, do not ignore the urge to go, do not strain or sit on the toilet for long, and use a bulk-forming laxative if constipation returns; keep the area clean with water rather than dry wiping, treat diarrhoea promptly, and use a lubricant for anal sex. An anal fissure returns in some people, and softening the poo at the first twinge usually stops it.
What causes an anal fissure?
Usually a large or hard poo tearing the lining, often with constipation and straining. Repeated diarrhoea, pregnancy and childbirth, anal sex and inflammatory bowel disease make fissures more likely.
Which ointment helps an anal fissure heal?
Prescription ointments that relax the muscle around the anus, such as glyceryl trinitrate or diltiazem, used for 6 to 8 weeks. About 7 in 10 chronic fissures heal with glyceryl trinitrate. A local anaesthetic ointment can ease the pain for a short time.
Can an online doctor treat an anal fissure?
Yes, usually. A doctor can recognise a typical fissure from your symptoms by video, advise on self-care and prescribe ointments and laxatives. A fissure that does not heal, or may have another cause, needs an examination in person.
- Anal fissure, NHS, National Health Service (UK), reviewed 26 June 2025.
- Anal fissure: patient information, Milton Keynes University Hospital NHS Foundation Trust, accessed 15 October 2026.
- Anal fissure, Cleveland Clinic (US), reviewed April 2023.
- Anal fissure: symptoms and causes, Mayo Clinic (US), updated 31 December 2024.
- Piles (haemorrhoids), NHS, National Health Service (UK), reviewed 1 April 2026.
- Bleeding from the bottom (rectal bleeding), NHS, National Health Service (UK), reviewed 12 April 2023.
- Constipation, NHS, National Health Service (UK), reviewed 26 October 2023.
- Hemorrhoids, MedlinePlus, US National Library of Medicine, reviewed July 2025.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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