How to Treat a Fissure? | Steps That Actually Work

Figuring out how to treat a fissure starts with understanding what it is—a small tear in the lining of the anus, usually caused by passing hard or large stools. The discomfort can be sharp, but the good news is most fissures resolve with consistent home care within a few weeks. The approach breaks down into two clear goals: stop irritating the tear and help the anal sphincter relax so it can heal.

The Two Goals of Fissure Treatment

Every treatment method serves one of two purposes. The first is reducing trauma to the tear—soft stools and gentle cleaning prevent the fissure from being reopened or worsened. The second is relaxing the anal sphincter muscle, which tends to clamp down in response to the pain, cutting off blood flow and slowing healing. Effective treatment tackles both at once.

Consistency matters more than intensity. A warm bath twice daily paired with steady fiber intake over several weeks outperforms aggressive short-term fixes that the person can’t maintain.

Step-by-Step Home Care That Works

The foundation of anal fissure treatment is home care, and it works for the majority of people. These steps address both soft stools and sphincter relaxation at the same time.

• Increase fiber to 25–35 grams per day using fruits, vegetables, whole grains, or a gentle supplement like psyllium husk. The goal is stool soft enough to pass without stretching the tear.
• Drink plenty of water—fiber works only when paired with enough fluid; otherwise it can make constipation worse.
• Take warm sitz baths for 10–20 minutes two to three times a day, especially after bowel movements. The warm water relaxes the sphincter muscle and increases blood flow to the area, which speeds healing. A regular bathtub works fine; you don’t need a special basin.
• Clean gently after each bowel movement using soft, unscented wipes or rinse with warm water. Pat dry—never rub. Avoid soap, wipes with alcohol or fragrance, and rough toilet paper.
• Use OTC pain relief as needed—acetaminophen or ibuprofen can help, and a thin layer of petroleum jelly or zinc oxide cream protects the area.

If you’re looking for a targeted product to support healing, cover both OTC and prescription-style options.

When to Consider Prescription Options

These are muscle-relaxing creams or ointments applied directly to the anal area, and they work by lowering sphincter pressure so the tear can get the blood flow it needs.

• Diltiazem 2% cream is often the first-line prescription option, applied twice daily for up to eight weeks. It’s an unlicensed preparation, meaning your pharmacist must compound it, but it has fewer side effects than alternatives.
• Nitroglycerin 0.4% ointment (Rectiv) is an alternative applied twice daily for up to eight weeks. It relaxes the sphincter effectively, but headaches are common—occurring in up to 30% of people—which limits its use for some patients.
• Botox injections and surgery are reserved for chronic fissures that haven’t responded to creams. A Botox injection temporarily paralyzes the sphincter muscle for several weeks, giving the tear time to heal. Lateral internal sphincterotomy—a small cut in the sphincter muscle—has a high success rate but is a last resort after other options fail.

Pain during bowel movements that doesn’t improve after two to three weeks of home care, or bleeding that continues beyond that window, means it’s time for a medical evaluation. A clinician can confirm the fissure is the real cause and rule out other conditions like hemorrhoids or inflammatory bowel disease.

Per the Cleveland Clinic’s anal fissure overview, most fissures heal with the conservative measures described here, and surgery is rarely needed when treatment begins early and stays consistent.