Expert Care for Anal Fissures | UNC REX Colorectal Surgery

Experience Relief With the Help of Our Colorectal Care Team

Pain from anal fissures can quickly interfere with your comfort, routine, and overall quality of life. At the Colorectal Division of North Carolina Surgery at UNC REX, our experienced colorectal surgeons provide compassionate care for patients dealing with painful anorectal conditions, including anal fissures, in Raleigh, North Carolina.

What Are Anal Fissures?

Anal fissures are tears in the lining of the anal canal, typically just inside the anus. These tears cause very sensitive nerve fibers to be exposed to constant irritation. Two main types of anal fissures can occur:

Acute anal fissure – These severe tears typically heal with appropriate medical treatment, often in less than six weeks.
Chronic anal fissure – These tears can last for months or even years, severely impacting quality of life.

Anal fissures most commonly occur in the back of the anal canal. Fissures in the front or on the sides of the canal are much less common.

What Causes Anal Fissures?

The two most common causes of anal fissures are constipation due to a large, hard stool or severe diarrhea. Fissures can also occur after suffering trauma to the anal area.

If you have hypertonicity (muscle tightness) of the anal canal and those muscles do not easily relax, you are at an increased risk for developing an anal fissure. On rare occasions, anal fissures can be caused by chronic medical conditions like Crohn’s disease, HIV, syphilis, tuberculosis, or cancer.

Symptoms of Anal Fissures

Symptoms typically include bleeding and severe pain while having a bowel movement. Pain after bowel movements can last for hours. Some patients may also notice a small amount of bright red blood on toilet paper or on the surface of the stool. Persistent discomfort can make patients hesitant to have bowel movements, which may contribute to an ongoing cycle of irritation.

Diagnosing Fissures

Diagnosing an anal fissure usually begins with a discussion of your symptoms, bowel habits, medical history, and how long the problem has been present. Your colorectal specialist will typically perform an examination of the anal area to identify the fissure and determine whether additional testing is appropriate, particularly if its location, appearance, or persistence suggests that another underlying condition could be contributing.

Medical Treatments for Anal Fissures

If you have an acute anal fissure, your surgeon will usually suggest a combination of medical treatments. An acute anal fissure has an 87 percent chance of healing with these treatments.

Your specialist may recommend one or more of the following:

Dietary changes

Your surgeon will recommend eating more fruits, vegetables, and whole grains to improve your fiber intake. Guidance will also include drinking several large glasses of water each day and avoiding foods that cause constipation, such as excessive amounts of red meat.

Stool-softening regimens

Over-the-counter stool softeners can help make your stool easier to pass and less painful.

Calcium channel blockers (CCBs)

This topical (applied directly to the skin) medication relaxes the anal sphincter muscle by increasing blood flow, thus allowing the fissure to heal. Diltiazem and nifedipine are the CCB ointments that surgeons most often prescribe. A compounding pharmacy will need to fill your prescription for CCBs, since they include a mixture of numbing creams for comfort.

Nitroglycerin ointment

Your surgeon may prescribe this topical medicine to help relax your sphincter muscle. Nitroglycerin ointment can be an effective treatment, but many people experience headaches as a side effect and cannot use it. You’ll need to use a compounding pharmacy to fill your prescription for this ointment since it also includes numbing creams.

If your anal fissure has not responded to the above treatments or if you have severe symptoms, your colorectal specialist might recommend Botox or sphincterotomy (anal fissure surgery). During a Botox procedure, it is injected into the anal canal while you are sedated. Botox relaxes the sphincter muscles. The effects of Botox last about three months, giving the fissure time to heal.

Sphincterotomy is performed with the patient under sedation. The surgeon makes a very small incision in the anal canal to relax the sphincter. This effective procedure is the gold standard for treating anal fissures, and it offers a success rate of more than 95 percent.

Recovery After Fissure Treatments

Recovery depends on the treatment used and the severity of the fissure, with non-surgical therapies generally requiring little interruption to normal activities and more invasive procedures sometimes involving a longer healing period. Your colorectal specialist will provide individualized aftercare instructions, monitor your progress, and help you maintain bowel habits that support healing and reduce irritation as the area recovers.

Why Choose UNC REX for Anal Fissure Therapy?

Fissures can be especially frustrating when symptoms persist despite attempts to manage them at home. At the Colorectal Division of North Carolina Surgery at UNC REX, our fellowship-trained colorectal surgeons have specialized experience treating conditions of the anus, rectum, and colon, and can recommend care based on the severity, duration, and possible causes of your fissures.

Our practice combines individualized colorectal care with access to the broader resources of the UNC Health® system, including advanced treatment options when conservative measures are not enough. We serve patients from Raleigh, Cary, Wake Forest, Apex, Holly Springs, Durham, and communities throughout the Triangle who are seeking knowledgeable, compassionate care for anal fissures and other colorectal concerns.

Benefits of Anal Fissure Treatment

Reduces pain during bowel movements
Promotes healing of damaged tissue
Helps decrease persistent irritation
Reduces bleeding associated with the fissure
Relaxes excessive sphincter tension
Options for both acute and chronic fissures
Supports improved daily comfort and quality of life

How Much Does Anal Fissure Therapy Cost?

The cost of anal fissure treatment varies based on the therapy recommended, whether a procedure is needed, and your individual insurance coverage. Our team can provide additional information about price considerations associated with your treatment plan.

FAQs

Are anal fissures contagious?

No, anal fissures cannot spread from one person to another. They also are not considered a sexually transmitted infection.

Can anal fissures come back after they heal?

Yes, an anal fissure can recur even after the area has completely healed. Repeated episodes should be discussed with a healthcare provider to determine whether there may be factors contributing to the problem.

Schedule an Appointment For Anal Fissure Treatment in Raleigh, NC

If you are seeking treatment for anal fissures in Raleigh, the colorectal specialists at UNC REX are here to help you find the best path toward relief. Contact us to schedule a consultation and learn more about your treatment options.

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Anal Fissures in Raleigh, NC