Fissures and haemorrhoids are different conditions that share some symptoms — both can cause bleeding and discomfort. A fissure is a tear in the skin lining of the anal canal, causing sharp, cutting pain during and after bowel movements; the pain can last minutes to hours. Haemorrhoids are swollen blood vessels that cause dull aching, pressure, itching, and painless bleeding, or a painful lump when clotted. The key distinguishing symptom is the quality of pain: fissure pain is sharp and directly linked to bowel movements, while haemorrhoid pain is more of a dull pressure. Both can coexist — another reason thorough examination matters. For detail on haemorrhoids, visit the hemorrhoid treatment page.

Acute fissures — those present for less than 6-8 weeks — heal on their own in the majority of cases, provided the underlying cause is addressed: softening stools with fibre and water, avoiding straining, and using sitz baths. Healing typically occurs within 4-6 weeks. Chronic fissures are less likely to heal spontaneously because of the cycle of internal sphincter spasm reducing blood flow. Without intervention (topical medication, botox, or surgery), a chronic fissure will usually persist, causing ongoing pain. If you have had symptoms for more than 8 weeks, or if they are worsening, it is worth being evaluated.

Lateral internal sphincterotomy is a short procedure — typically 10-15 minutes — and most patients go home the same day. Pain relief from the chronic fissure is often noticed within days as the sphincter spasm resolves. The surgical wound itself heals over 2-4 weeks. Most patients return to desk work within 3-5 days, physical work in 1-2 weeks. Sitz baths, stool softeners, and a high-fibre diet continue during recovery. Post-operative pain is generally much less than the pre-operative fissure pain that brought you in. Follow-up is at 2 and 6 weeks to confirm complete healing. See the recovery science page.

Recurrence after surgery is uncommon — reported at under 5% when the patient keeps up fibre, water, and good bowel habits. If a fissure does recur, we do not simply repeat the operation: we look for a secondary cause (such as Crohn's disease) and investigate. Successful surgery plus a lasting change in habits is what gives a durable result.

A fissure itself does not become cancerous. However, an atypical fissure — one that is off to the side, multiple, or non-healing despite proper treatment — may point to an underlying condition such as Crohn's disease, tuberculosis (in endemic areas), or, rarely, anal cancer. This is precisely why a thorough diagnostic approach matters: if a fissure does not behave as expected, we investigate further rather than simply repeating the same treatment. A chronic, non-healing fissure also affects quality of life through persistent pain and fear of bowel movements. Learn more about when surgery is and is not needed.