What is anal fissure?
An anal fissure is a small split or tear in the skin lining the anal canal, usually caused by passing a hard or large stool. It typically causes sharp, sometimes severe pain during and after bowel movements, often with a small amount of bright red blood. The pain causes the internal sphincter muscle to spasm, which reduces blood flow to the tear and stops it healing, creating a frustrating cycle.
Fissures affect men and women of all ages, including after childbirth, and are strongly linked to constipation. Diagnosis is usually made from the history and a gentle inspection; internal examination is often deferred because of pain. A fissure lasting more than six weeks is classed as chronic and is less likely to heal without specific treatment.
Common symptoms
- Sharp, often severe pain when passing a stool
- Burning or gnawing pain lasting minutes to hours afterwards
- Bright red blood on the toilet paper
- Fear of opening the bowels, which worsens constipation
- Itching or irritation around the anus
- A small skin tag at the edge of the fissure in chronic cases
How long will you wait?
A routine NHS referral for a persistent fissure commonly takes several months to reach clinic and any day-case procedure, with many patients waiting beyond the 18-week standard on current general surgery lists.
Privately, you can typically see a consultant within 3–7 days, with Botox treatment or surgery, if needed, usually scheduled within 2–4 weeks.
NHS England median referral-to-treatment wait: 12.4 weeks, with 2.5 million people waiting over 18 weeks (May 2026). Individual waits vary by trust and urgency.
Treatment options
- Stool softening and hygiene. Fibre, fluids, laxatives if needed and warm baths relax the sphincter and let many acute fissures heal.
- GTN or diltiazem ointment. Prescription creams that relax the sphincter muscle and improve blood flow, healing most chronic fissures over six to eight weeks.
- Botulinum toxin injection. A day-case injection into the sphincter that relieves spasm for two to three months to allow healing.
- Lateral internal sphincterotomy. A small operation dividing part of the internal sphincter; the most effective treatment for resistant fissures.
What does private treatment cost?
As a guide, private treatment for anal fissure typically costs around £1,500–£2,500 for Botox injection and around £2,000–£3,500 for sphincterotomy in the UK in 2026.
Does health insurance cover anal fissure?
An anal fissure arising after your policy begins is an acute condition, so consultations, prescribed treatment and any day-case procedure are usually covered by private medical insurance. A fissure that predates your policy, or symptoms you had before joining, will normally be excluded as pre-existing at first. GP-prescribed creams obtained outside the private pathway are generally not reimbursable, so check how your policy handles outpatient medication.
Frequently asked questions
How can I tell a fissure from piles?
Both can cause bright red bleeding, but the pattern of pain differs. A fissure typically causes sharp, cutting pain during the bowel movement itself, often followed by hours of burning ache, whereas haemorrhoids more often cause painless bleeding, itching or a lump. The two can coexist, and only an examination can confirm the diagnosis, so persistent symptoms deserve a proper assessment.
Do fissures heal on their own?
Acute fissures often do, usually within a few weeks, provided stools are kept soft and you avoid straining. Warm baths after bowel movements help relax the sphincter. If a fissure persists beyond about six weeks it becomes chronic, the muscle spasm keeps reopening the tear, and prescription ointments, Botox or minor surgery are usually needed to break the cycle.
Is sphincterotomy safe? I have heard it can affect continence.
Lateral internal sphincterotomy heals over 90 per cent of chronic fissures and is quick, day-case surgery. The main concern is a small risk of minor continence changes, most often temporary difficulty controlling wind. Surgeons minimise this by dividing only a small portion of the muscle and by selecting patients carefully; women who have had childbirth injuries are assessed particularly cautiously beforehand.