Anal Fissure: Symptoms, Treatment and How It Differs from Piles

Last updated: 11 Nov 2026

Sharp pain when you pass a stool, sometimes with a little bright red blood on the toilet paper, can be distressing. A common cause is an anal fissure, a small tear in the lining of the anus.[1][2] Piles can cause bleeding too, so it helps to know how an anal fissure vs piles may feel different. This guide covers symptoms, self-care, anal fissure treatment options, and when to see a doctor.

What is an anal fissure?

An anal fissure is a small tear in the skin that lines the anus, the opening at the end of the bowel.[1][2] The area is sensitive, so passing a stool can be very painful, and the discomfort may continue afterwards. Fissures can occur at any age. They are more often seen in people aged 15 to 40, and they also occur in young children; this guide is written for adults.[1]

Symptoms of an anal fissure

The main symptoms are:[1][2]

• severe, sharp pain when you poo
• a burning or aching pain afterwards, which may last for several hours
• bright red blood in the toilet bowl or on the toilet paper after you poo
• itching around the anus, in some people

Pain with passing a stool is more typical of a fissure than of many internal piles, which often bleed with little or no pain.[3] New bleeding should still be checked, as it can have other causes — see blood in stool.

Anal fissure vs piles

An anal fissure vs piles (haemorrhoids) is a distinction people often want to make, because both can cause bright red blood after a bowel motion. They are different conditions:[1][3][4]

• A fissure is a tear in the lining of the anus. The stand-out symptom is usually sharp pain when you poo, sometimes followed by a burning ache. Bleeding, if it happens, tends to be a small amount of bright red blood on the paper or in the bowl.
• Piles are swollen blood vessels in and around the anus. They may bleed, itch, or feel like a lump, and bleeding piles are often painless. Pain is more likely if an external pile has a blood clot in it, or if a pile is swollen.

The two can also occur together, especially if constipation and straining are in the background. You cannot reliably tell them apart at home, so a doctor's examination is the way to confirm the cause. Our guide to haemorrhoids (piles) covers piles in more detail.

What causes an anal fissure?

The usual trigger is a hard, dry stool that tears the lining as it passes.[1][2] Constipation is therefore a common cause. Other factors that can make a fissure more likely include frequent diarrhoea, pregnancy or a vaginal birth, inflammatory bowel disease (such as Crohn's disease or ulcerative colitis), a sexually transmitted infection, and, less often, another condition such as cancer that needs ruling out.[1][2] If a fissure is linked to another condition, treatment also needs to address that cause. It is not always clear why a particular fissure has formed.[1]

Looking after a fissure at home

Many people find these steps ease pain and help the tear settle:[1][2]

• Keep stools soft. Eat more fibre (fruit, vegetables, wholegrains, beans and lentils), adding it gradually, and drink plenty of fluids, especially water.
• Go when you feel the urge, rather than holding on, and try not to strain or sit on the toilet for longer than you need to.
• Take a warm, shallow bath after you poo to ease pain, and pat the area dry instead of rubbing. Keep the area clean and dry.
• Ask a pharmacist about short-term pain relief such as paracetamol or ibuprofen, and about laxatives or stool softeners if constipation is part of the problem. Check first if you are pregnant, breastfeeding, take other medicines, or have other health conditions.

Once a fissure has settled, the same habits — softer stools, going when you feel the urge, and not straining — may also lower the chance of another tear.[1][2]

Anal fissure treatment

An anal fissure often improves with the self-care steps above. If it is not healing, symptoms are getting worse, or the tear keeps coming back, a doctor may recommend further anal fissure treatment.[1][2] Options can include laxatives to keep stools soft, medicines to ease pain or muscle spasm, and a cream or ointment prescribed to help the tear heal.

If these measures are not enough, a procedure may be considered, such as an injection into the muscle around the anus to help it relax, or a small cut in that muscle to reduce tension. These are usually carried out by a surgeon, often under a general anaesthetic.[1][2]

Your doctor can explain which option, if any, is appropriate, along with the possible benefits and risks. Questions about procedures or practical arrangements can be raised at a consultation; you can contact the clinic or request an appointment. Anal operations are not listed on the clinic's services page, so any discussion of an injection or surgery would be about whether a referral to a surgeon is appropriate, not about having the procedure here.

How an anal fissure is diagnosed

A doctor will usually ask about your symptoms and bowel habits and look at the area around the anus. That examination is often enough to see a fissure.[1][2] If the diagnosis is unclear, the examination is too painful, or another condition needs to be ruled out, you may be referred for a further look, sometimes under anaesthetic.[1] Your doctor may also suggest looking further along the bowel. Our guides to colonoscopy and gastroscopy and colorectal cancer screening in Singapore explain these checks. Practical details of any test are explained at a consultation.

When to see a doctor

See a doctor if pain or bleeding is getting worse or is not improving with self-care, the fissure keeps coming back, bleeding is not clearly linked to passing a stool, you notice a lasting change in bowel habit or stool shape, you have unexplained weight loss, a hard lump, pus, a high temperature, or you feel unwell.[1][3][4] Some of these symptoms can overlap with piles, inflammatory bowel disease or bowel cancer, which is why they need a review.[2][3][4] See IBS vs IBD and Crohn's disease vs ulcerative colitis for more on IBD.

Get urgent medical help (call 995 or go to the nearest Emergency Department) if you have bleeding that will not stop, are passing a lot of blood or large clots, have severe pain, or feel faint or dizzy.

Related reading

• Haemorrhoids (piles): symptoms, causes and treatment options
• Constipation: causes, symptoms and when to see a doctor
• Blood in stool: common causes and when to see a doctor
• IBS vs IBD: understanding the difference
• Colorectal cancer screening in Singapore
• Digestive and liver care at KL Ling Gastroenterology and Liver Clinic

Frequently asked questions

What is an anal fissure?

It is a small tear in the lining of the anus. The usual symptoms are sharp pain when you poo, a burning ache afterwards, and sometimes a little bright red blood on the toilet paper or in the bowl.[1][2]

How is an anal fissure vs piles different?

A fissure is a tear and typically causes sharp pain with a bowel motion. Piles are swollen blood vessels; they may bleed, itch or form a lump, and bleeding is often painless. The two can occur together, and a doctor needs to examine you to tell them apart.[1][3]

What anal fissure treatment is usually tried first?

Self-care comes first: softer stools, not straining, warm baths, and pharmacy advice on pain relief or laxatives. If that is not enough, a doctor may prescribe an ointment or other medicines. A procedure or surgery, if needed, is usually carried out by a surgeon.[1][2]

Can constipation cause a fissure?

Yes. A hard, dry stool is a common cause. Softening stools helps healing and may lower the chance of another tear.[1][2] See our constipation guide.

Do I need a test such as a colonoscopy?

Not always. Many fissures are diagnosed by looking at the anus. Further tests may be suggested if the diagnosis is unclear, the tear does not settle, or there are other warning symptoms.[1]

When should I see a doctor?

See a doctor if pain or bleeding is not improving, keeps returning, or comes with a change in bowel habit, unexplained weight loss, a lump, pus, or bleeding not clearly tied to passing a stool.[1][4]

Sources

1. NHS. Anal fissure. https://www.nhs.uk/conditions/anal-fissure/
2. SingHealth. Anal Fissure. https://www.singhealth.com.sg/symptoms-treatments/anal-fissure
3. NHS. Piles (haemorrhoids). https://www.nhs.uk/conditions/piles-haemorrhoids/
4. HealthHub (Ministry of Health, Singapore). Piles. https://www.healthhub.sg/health-conditions/piles