Fissure (Fisher Disease): Symptoms, Causes, Home Care and Treatment
An anal fissure (often searched as "fisher disease" or "fisher problem") is a small tear in the skin at the anal opening.
In short
An anal fissure (often searched as "fisher disease") is a small tear in the skin at the anal opening. It causes sharp pain during and after passing stool, often with a little bright red blood, and most new fissures heal in a few weeks with fibre, water, stool softeners and warm sitz baths.
Key takeaways
- An anal fissure (often searched as "fisher disease" or "fisher problem") is a small tear in the skin at the anal opening. It causes sharp pain during and after passing stool, often with a little bright red blood.
- Most new fissures heal in a few weeks with fibre, water, stool softeners and warm sitz baths.
- A fissure that lasts more than 6–8 weeks is "chronic" and usually needs prescription ointments, Botox injection or a small operation.
- See a doctor if bleeding is heavy, the pain does not settle, you are over 45 with new bleeding, or the fissure is not in the usual place.
What is an anal fissure (fisher disease)?
An anal fissure is a small cut or tear in the thin lining (anoderm) at the lower end of the anal canal. In Hindi it is often called "fissure" or "fisher" and confused with piles. Most fissures are in the back midline of the anus. Passing a hard stool stretches the lining and tears it; the pain then makes the anal muscle (internal sphincter) go into spasm, which reduces blood flow and slows healing. This pain-spasm cycle is why fissures can keep coming back.
- Acute fissure: present for less than about 6 weeks. Looks like a fresh paper cut and usually heals with simple measures.
- Chronic fissure: lasts longer than 6–8 weeks, often with a small skin tag (sentinel pile) and exposed muscle fibres at the base.
Symptoms
- Sharp, cutting or burning pain during a bowel movement, often lasting minutes to hours afterwards.
- Bright red blood on toilet paper or streaked on the stool, usually a small amount.
- Fear of passing stool, which leads to holding back, harder stools and more pain.
- A visible tear or a small skin tag at the edge of the anus, and itching or discharge in some people.
Causes and risk factors
- Constipation and hard stools, the most common cause, often from low fibre and low water intake.
- Frequent diarrhoea.
- Childbirth and straining during pregnancy.
- A tight anal sphincter (high resting muscle tone).
- Less common causes: Crohn's disease, tuberculosis, sexually transmitted infections, HIV and, rarely, cancer. These often cause fissures in unusual positions (to the side rather than front or back) and need investigation.
Fissure vs piles vs fistula: what is the difference?
| Fissure | Piles (haemorrhoids) | Fistula | |
|---|---|---|---|
| What it is | A tear in the anal lining | Swollen blood vessels (cushions) in the anal canal | A tunnel between the anal canal and the skin near the anus |
| Pain | Sharp, severe pain during and after stool | Usually painless unless a clot forms (thrombosed pile) | Aching pain and swelling, worse when an abscess forms |
| Bleeding | Small amount of bright red blood | Bright red blood, can be more, often painless | Usually pus or blood-stained discharge rather than bleeding |
| Lump | Small skin tag in chronic fissure | Soft lump that may come out (prolapse) | A small opening on the skin that keeps discharging |
| Usual first treatment | Fibre, sitz baths, ointments | Fibre, avoiding straining, medicines; banding or surgery if needed | Needs surgery; does not heal with medicines alone |
Home care for an anal fissure
- Fibre: aim for about 25–30 g a day from vegetables, fruit, dal, whole grains and isabgol (psyllium husk) as advised by your doctor.
- Water: drink enough that your urine stays pale.
- Warm sitz baths: sit in a tub of plain warm water for 10–15 minutes, two to three times a day and after passing stool. This relaxes the anal muscle and eases pain.
- Do not strain or sit on the toilet for long periods; go when you feel the urge.
- Keep the area clean and dry; pat with soft tissue or wash with water instead of rubbing.
- Limit very spicy food and alcohol if they worsen your symptoms.
Medical treatment
If a fissure does not heal with home care, or is already chronic, a doctor may prescribe:
- Stool softeners or laxatives to keep stools soft.
- Ointments that relax the anal muscle (a calcium-channel blocker such as diltiazem, or nitroglycerin), usually for 6–8 weeks. Nitroglycerin can cause headaches.
- Local anaesthetic gels for short-term pain relief.
- Botulinum toxin (Botox) injection into the anal muscle, which relaxes it for a few months while the fissure heals.
Do not use steroid creams for long periods without medical advice.
When is surgery needed?
Surgery is considered for chronic fissures that do not heal with medicines. The standard operation is lateral internal sphincterotomy (LIS), a small cut in part of the internal anal muscle to relieve spasm. It has high healing rates; a small risk of minor leakage of gas or stool is discussed before surgery. Fissurectomy (removing the scarred edge) may be combined with Botox in some patients.
When to see a doctor
- Pain or bleeding that does not improve after 1–2 weeks of home care
- Heavy bleeding, black stools, or blood mixed in the stool
- New rectal bleeding if you are over 45, or a family history of bowel cancer
- Fever, a swelling near the anus, or discharge of pus (possible abscess or fistula)
- Diarrhoea, weight loss or abdominal pain along with the fissure (possible Crohn's disease)
A gastroenterologist can examine the area and, if needed, arrange a colonoscopy to rule out other causes of bleeding.
Frequently Asked Questions
What is fisher disease?
"Fisher disease" is a common way of writing anal fissure: a small tear in the skin at the anal opening that causes sharp pain and a little bright red bleeding when passing stool.
How long does a fissure take to heal?
Most acute fissures heal within 2 to 6 weeks with fibre, fluids and sitz baths. Fissures lasting more than 6 to 8 weeks are chronic and usually need prescription treatment.
Is a fissure the same as piles?
No. A fissure is a tear and is very painful during stool. Piles are swollen blood vessels that often bleed without pain. The treatments are different, so a doctor should examine you.
Can a fissure heal without surgery?
Yes, in most people. Home care heals most new fissures, and ointments or Botox heal many chronic ones. Surgery is kept for fissures that do not respond.
Can a fissure turn into cancer?
A typical fissure does not turn into cancer. However, rectal bleeding can have other causes, so see a doctor if bleeding continues, you are over 45, or the fissure is in an unusual position.
Conclusion:
An anal fissure is painful but usually treatable. Soft stools, fibre, water and warm sitz baths heal most new fissures; ointments, Botox or a small operation help chronic ones. If symptoms last more than a couple of weeks or bleeding is heavy, see a doctor to confirm the diagnosis.
References
- Davids JS, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures. Dis Colon Rectum. 2023;66(2):190-199. Source
- Management of Anal Fissures: Guidelines From the American Society of Colon and Rectal Surgeons (practice guideline summary). Am Fam Physician. 2024. Source
Medical disclaimer: This article is for general education and is not a substitute for a consultation. Please see a doctor for advice about your own symptoms. Read our editorial policy.