Written and medically reviewed by: Assoc. Prof. Cengiz Dibekoğlu, MD, General SurgeryLast updated:
Anal Fissure
Diet, topical therapy, Botox, and LIS
Most acute fissures heal without cutting the sphincter — chronic fissures need a stepwise plan.
An anal fissure is a tear in the anoderm that causes severe pain with bowel movements, often with bright red blood on the paper. Acute fissures frequently heal with soft stools, fiber, fluids, and topical agents that reduce sphincter spasm. Chronic fissures may need Botox (chemical sphincterotomy concept) or, in selected failures, lateral internal sphincterotomy (LIS). Continence risk is discussed before any sphincter-dividing surgery. Crohn’s disease and infection can mimic fissures — the diagnosis should be confirmed, not assumed forever as “constipation tear.”
Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Figure summary
- Hero figure: anal canal with fissure location as an educational overview.
- Related figures cover chronic fissure, Botox, and lateral internal sphincterotomy concepts.
Educational figures
Tap a figure to enlarge. These English illustrations mirror the Turkish hub gallery for this condition.
Diet Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Botox Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
LIS Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Start gentle
Fiber, fluids, and soft stools first.
Topicals / Botox
Reduce sphincter spasm in chronic fissures.
LIS when needed
Effective for selected chronic cases; continence discussion required.
Rule out mimics
Crohn’s and infection can look similar.
What to know
Pain pattern
Sharp pain during and after defecation with bright blood is classic. Fear of stools can worsen constipation and perpetuate the tear.
Conservative care first
Most acute fissures heal without surgery when stool softness and topical therapy are applied consistently.
Botox bridge
Injection can temporarily reduce internal-sphincter hypertonia in chronic fissures when topicals fail — useful before committing to LIS in many patients.
- Key note inside
Surgery last for many
LIS is powerful for selected chronic fissures after failed conservative care. Even a controlled sphincterotomy requires an honest continence talk.
- Key note inside
When it is not “just a fissure”
Atypical location, multiple tears, severe inflammation, or systemic clues push evaluation for Crohn’s or other disease.
What happens next
Glass-shard pain, bleeding, and when to seek care
- 1
Anal Fissure Symptoms
Glass-shard pain, bleeding, and when to seek care
Read this chapter - 2
Anal Fissure Diagnosis
Exam, acute vs chronic, and important differentials
Read this chapter - 3
Medical / Topical Treatment
Soft stools, sitz baths, NTG and diltiazem creams
Read this chapter - 4
Diet for Anal Fissure
Diet — explained for shared decision-making
Read this chapter - 5
Botox for Anal Fissure
Botox: what the procedure aims to do and who it fits
Read this chapter - 6
Lateral Internal Sphincterotomy
LIS: what the procedure aims to do and who it fits
Read this chapter
Evidence
Scientific sources
Show sources · 2ASCRS guidance framing medical therapy, botulinum toxin, and LIS decisions for anal fissure.
Evidence
Scientific sources
- 1. ASCRS clinical practice guideline — anal fissureASCRS · Guideline libraryOpen source →
- 2. ASCRS clinical practice guidelines libraryAmerican Society of Colon & Rectal Surgeons (ASCRS) · Guideline libraryOpen source →
Last reviewed: 21 August 2026. Links go to publisher pages.
Appointment / info
Severe pain with bowel movements deserves proctologic evaluation — especially if topical care has already failed.
This page is for education. It is not medical advice and does not replace a visit with your physician.
Medical editor: Assoc. Prof. Cengiz Dibekoğlu, MD · English patient-education hub.