Anal Fissure: Symptoms, Treatment and When to See a GP
Medically Reviewed by Dr. Pedro Yelamo Vera, MD
Licensed Physician No. 484814280 · Official Medical College of Bizkaia (Spain)Last reviewed: 5 November 2026
An anal fissure is a small tear that hurts when you poo.
You don't have to figure this out alone
Dr. Pedro Yelamo Vera is an independent, bilingual GP licensed in Spain. Book a 15-minute video consultation in English or Spanish for €50, with a private electronic prescription issued under Spanish law when clinically appropriate.
An anal fissure is a small tear in the skin of the anus. It causes sharp pain when you poo, burning that lasts for hours afterwards and sometimes bright red blood on the paper. Most heal within a few weeks with fibre, water, warm baths and no straining. This guide is by Dr. Pedro Yelamo Vera, an English-speaking GP licensed in Spain (Colegiado No. 484814280) who sees patients by video in English and Spanish.
- An anal fissure is a small cut at the edge of the anus, usually from hard poo or diarrhoea.
- The typical sign is very sharp pain, like passing glass, when you poo, with bright red blood.
- Treat it with fibre, plenty of water, warm shallow baths and simple painkillers. Do not hold in a poo.
- If it does not heal, a doctor may prescribe a cream that relaxes the anal muscle. After 6 weeks it is called chronic.
- A painful lump near the anus with a fever may be an abscess. It needs to be seen in person the same day.
- Call 112 if you bleed heavily and feel faint or pass out.
What is an anal fissure?
It is a long, thin tear in the delicate skin at the end of the anus. It is usually at the back. Each poo opens it again, so it hurts and is slow to close.
The pain makes the ring muscle of the anus (the sphincter) tighten. That spasm cuts the blood supply and slows healing. This is why some fissures become long-term. In Spain it is called a fisura anal.
What are the symptoms of an anal fissure?
- Sharp, severe pain when you poo.
- Burning pain that can last several hours after.
- Bright red blood on the toilet paper or in the toilet.
- Sometimes a small skin tag next to the tear.
What causes an anal fissure?
The most common cause is constipation with hard poo. Others are frequent diarrhoea, pregnancy and giving birth, bowel disease (Crohn's disease or ulcerative colitis) and some sexually transmitted infections. It is most common between 15 and 40, and in young children.
Is it a fissure or piles?
Both can bleed. A fissure hurts a lot when you poo. Piles (haemorrhoids) usually bleed with less pain and feel like soft lumps. You can have both. Read about piles and their treatment.
How do you heal an anal fissure at home?
Most heal on their own once poo is soft and the area is no longer irritated:
- Eat more fibre: fruit, vegetables, beans and wholemeal bread.
- Drink water through the day.
- Do not hold in a poo, and do not strain.
- Sit in a warm, shallow bath for a few minutes after a poo. It relaxes the muscle and eases pain.
- Clean the area gently with water and pat it dry.
- For pain you can take paracetamol or ibuprofen. Follow the leaflet.
What treatment is there for an anal fissure?
If it is not better in a week, see a doctor. They may suggest:
- a gentle laxative if you are constipated;
- a cream that relaxes the sphincter so the tear can close; in Spain it needs a prescription and is often used for several weeks;
- if that fails, a specialist may offer a botulinum toxin (Botox) injection or a small operation to relax the muscle.
The doctor sets the treatment and how long it lasts. There is no single plan for everyone.
How long does an anal fissure take to heal?
A new fissure often heals in a few weeks with these steps. If it lasts more than about 6 weeks it is called chronic. It may then need prescription treatment or a surgeon's opinion.
Why is my bottom itchy?
An itchy bottom is very common and is rarely serious. Usual causes are:
- damp, sweat or traces of poo;
- washing too much, or using scented soaps and wipes;
- piles or a fissure;
- a fungal infection or a skin problem such as eczema;
- in children, threadworms, with itching that is worse at night; read about threadworms in children;
- some foods and drinks, such as coffee, spicy food or alcohol.
It helps to wash with water only, dry well, wear cotton underwear and not scratch. If it lasts more than a few weeks, see a doctor.
What if it is an abscess or a fistula?
An anal abscess is a pocket of pus next to the anus. It gives constant, throbbing pain, a red, hot lump and sometimes a fever. Creams do not help. It needs draining in person, often the same day in A&E.
A fistula is a small tunnel between the anus and the skin. It often follows an abscess. Pus or a smelly fluid leaks near the anus again and again. It nearly always needs surgery, so a GP refers you to a surgeon.
What do I ask for at a Spanish pharmacy?
Say tengo una fisura anal or me duele al hacer de vientre. A pharmacist can suggest a gentle laxative or fibre. Creams that heal a fissure need a doctor's prescription.
When to see a doctor
- The pain or bleeding is not better after 7 days of home care.
- Fissures keep coming back.
- Dark blood, blood mixed in with your poo, or black poo.
- A change in your bowel habit for weeks, especially over 50.
- Weight loss for no reason, tiredness or pale skin.
- Pus leaking from the anus, or a lump that does not go.
When to go to A&E or call 112
- A very painful lump by the anus with a fever: go to A&E (urgencias) the same day.
- Heavy bleeding that will not stop.
- Dizziness, fainting, very pale skin or a racing heart with the bleeding: call 112.
Frequently asked questions about anal fissures
Does an anal fissure heal by itself?
Many do, within a few weeks, once your poo is soft. If it is not better in a week, see a doctor.
What cream is best for an anal fissure?
Piles creams may soothe a little. The creams that help a fissure close relax the sphincter and need a prescription. A doctor decides.
Is bleeding from a fissure serious?
It is usually a small amount of bright red blood and is not serious. See a doctor if the blood is dark, mixed with poo or heavy.
What should I avoid eating with a fissure?
Avoid things that constipate you, such as lots of sweets, white flour or too little fluid. Spicy food and alcohol can make the burning worse.
Can a doctor assess an anal fissure by video?
A doctor can talk through your symptoms by video, advise on first treatment and decide if you need an exam in person.
Getting a medical assessment
If you are in Spain and have anal pain or bleeding, you can book a video consultation with Dr. Pedro Yelamo Vera, a physician registered in Spain. You can also read about stool colour. A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.
This guide is general information. It does not replace the package leaflet or the advice of your doctor or pharmacist.
Sources
This content is written and reviewed by a licensed physician with reference to the following sources.
