Anal Fissure

An anal fissure is a tear or ulcer that develops in the lining of the anal canal (back passage).


  • The commonest symptom of anal fissure is a sharp pain when you pass stool. The pain can last for several minutes after opening your bowels.
  • Most people note some blood on the toilet paper or on stools after opening their bowels

Diagnosis and Treatment:

  • Diagnosis is usually by clinical examination which may some time require a general anaesthetic if the clinical examination is too painful.
  • Most fissures will heal spontaneously by avoiding constipation and including fibre in your diet

Medical Treatment:

  • You are prescribed Diltiazem cream. This is applied for 6 to 8 weeks and causes muscles around the back passage to relax to allow fissure to heal.
  • The common side effects of Diltiazem are headaches which usually gets better after a week and occasionally itching around the anus.


  • If Diltiazem cream does not heal fissure , your consultant will discuss the option of injecting Botox into the sphincter muscles. This causes the muscles to relax and allows fissure to heal. This is usually done under general anaesthetic but can be performed in outpatient clinic without anaesthetic.
  • The most common side effect of Botox treatment is minor degree of incontinence to flatus or faeces which can last for few weeks.
  • Lateral Sphincterotomy: This is carried out under general anaesthetic. A small portion of the sphincter muscle is divided to reduce the muscle tension so that fissure can heal. This is very successful procedure but carries a small risk of incontinence.


  • You will be seen in the clinic 2 to 3 months after your initial treatment to assess the response