An anal fissure is a small, painful tear in the lining of the anus, often causing discomfort and bleeding during bowel movements. While this condition can be distressing, effective treatment options are available. Dr. Albert Chung is a specialized colorectal surgeon in Santa Margarita dedicated to the careful diagnosis and personalized treatment of anal fissures. Our clinic provides advanced yet compassionate care tailored specifically to your needs. To schedule your appointment, call us at (714) 988-8690 today.
An anal fissure is a small tear in the lining of the anal canal. Fissures are one of the most common causes of severe anal pain, especially with bowel movements. Most are caused by the mechanical stress of passing large or hard stools, but persistent or recurring fissures sometimes point to underlying conditions that deserve evaluation.
Fissures are uniquely painful because of a self-reinforcing cycle involving the anal sphincter muscle.
Breaking this cycle is the core principle behind most fissure treatments. Softening stools reduces new trauma, and relaxing the sphincter muscle restores blood flow to allow healing.
Fissures are categorized by how long they've been present. The distinction matters because it shapes treatment.
Most fissures are mechanical, caused by the passage of hard or large stools that stretch the anal canal beyond what the tissue can handle. But other factors contribute too.
Fissures may not be easily visible because of their location, but the symptoms are usually recognizable.
During your consultation, Dr. Chung will review your symptoms and medical history, and perform a gentle physical examination. Most fissures can be identified on visual inspection. In some cases, a very gentle anoscopy may be used, though if pain is severe the exam may be limited until initial treatment has eased symptoms. If there's any concern about underlying conditions, additional testing like colonoscopy may be recommended.
Treatment follows a stepwise approach, starting with the simplest options and escalating as needed. Most fissures never need more than the first step.
Once a fissure has healed, these habits significantly reduce the chance of another one.
Recovery depends on the treatment. Conservative care and topical medications require no downtime but several weeks of consistent use. Botox injection is done in the office with immediate return to daily activities. Surgical treatment with lateral internal sphincterotomy typically involves minimal downtime, with most patients resuming normal activities within one to two weeks. Dr. Chung provides detailed aftercare instructions covering wound care, activity guidelines, and bathroom habits to support smooth healing.
A colorectal surgeon (also called a proctologist) is the specialist for anal fissures. Primary care physicians and gastroenterologists can start conservative treatment, but a fissure that has not healed after six weeks, a fissure that keeps coming back, or a fissure in an unusual position should be examined by a colorectal specialist. Colorectal surgeons are the only physicians trained in the full range of fissure treatment, from prescription ointments through Botox and sphincterotomy, and they are trained to recognize the uncommon fissures that signal Crohn's disease, infection, or cancer. Dr. Chung is double board-certified in general surgery and colon and rectal surgery and treats fissures every week. Read when a specialist is worth it.
Both cause bright red bleeding. The pain tells you which one you are dealing with.
| Clue | Anal fissure | Hemorrhoid |
|---|---|---|
| Pain | Sharp, cutting pain during the bowel movement, often followed by a burning ache for minutes to hours | Internal hemorrhoids are usually painless; external ones ache or throb, especially when swollen |
| Bleeding | A bright red streak on the stool or the paper | Bright red blood on the paper or dripping into the bowl, usually painless |
| What you feel | Sometimes a small skin tag at the edge of the anus, sometimes nothing | A soft lump, or tissue that pushes out and goes back in |
| Fear of going | Common; patients hold stool, which makes it harder and worsens the tear | Less common |
| Treatment page | This page | Hemorrhoid treatment |
A fissure that is still there after six to eight weeks has usually become chronic, and the reason it will not heal is almost always the same: the internal sphincter is in spasm, blood flow to the tear is reduced, and every bowel movement reopens it. Creams alone rarely fix a chronic fissure because they cannot break that cycle for long enough. This is where prescription treatment matters. Nifedipine or diltiazem ointment relaxes the sphincter and heals roughly 60 to 70 percent of chronic fissures over six to eight weeks. Botox injection into the sphincter heals a similar proportion of the fissures that ointment did not, with a single office visit. Lateral internal sphincterotomy heals more than 90 percent and is the American Society of Colon and Rectal Surgeons' recommended treatment for chronic fissures that have failed medical therapy.
A chronic fissure in an unusual location (on the side of the anal canal rather than directly front or back), multiple fissures, or a fissure with a lot of swelling deserves a closer look, because those patterns can point to Crohn's disease, an infection, or rarely a cancer. Dr. Chung examines every chronic fissure with that in mind.
Fissure pain makes people avoid the doctor as much as it makes them avoid the bathroom. Dr. Chung's first visit is built around that: a gentle exam, sometimes limited until the pain is under control, a clear explanation of what is going on, and a prescription plan you start the same day.
Dr. Chung sees patients at 30212 Tomas, Suite 365, Rancho Santa Margarita, CA 92688, off the 241 toll road in South Orange County. Patients come from Mission Viejo, Lake Forest, Irvine, Laguna Hills, Laguna Niguel, Aliso Viejo, San Juan Capistrano, Ladera Ranch, Trabuco Canyon, Santa Ana, and across Orange County. Most new patients are seen within days, and a first visit usually includes the exam, a plain-language explanation, and a treatment plan the same day.
Not ready for an in-person visit? Dr. Chung also offers online video consultations. Read what patients say on the reviews page.
A colorectal surgeon. Primary care can start fiber and ointment, but fissures that last more than six weeks, recur, or sit in an unusual position should be examined by a colorectal specialist, who can offer prescription ointments, Botox, and sphincterotomy and can recognize fissures caused by other conditions.
Acute fissures usually heal in two to four weeks with fiber, water, stool softeners, and sitz baths. Chronic fissures treated with nifedipine or diltiazem ointment take six to eight weeks. After Botox, healing typically occurs over four to eight weeks. After sphincterotomy, most fissures heal within two to four weeks, and pain relief is often immediate.
Most acute fissures do, provided stool stays soft and the tear is not reopened. A fissure that has not healed after six weeks has usually become chronic and is unlikely to close without prescription treatment, because sphincter spasm is now preventing it.
Lateral internal sphincterotomy is a short outpatient procedure with a healing rate above 90 percent. A small proportion of patients notice minor changes in control of gas or minor seepage, which is usually temporary. Dr. Chung divides only the amount of muscle needed and discusses the risk with every patient beforehand. Botox is offered as an alternative for patients who prefer to avoid surgery or who have any pre-existing continence concerns.
Ointment and Botox involve no downtime. After sphincterotomy, most patients with desk jobs return within a few days and to full activity within one to two weeks.
Anything that hardens stool or causes constipation for you: low-fiber processed foods, large amounts of cheese, and dehydration from alcohol. Spicy food does not cause fissures but can sting on the way out. Focus on adding fiber and water rather than eliminating foods.
When a chronic fissure has not healed after eight weeks of prescription ointment, or after Botox, or when pain is severe enough that you cannot function. Sphincterotomy is also reasonable earlier for patients who have had multiple recurrences and want a definitive fix.
Rarely. Anal cancer can occasionally look like a fissure that does not heal, which is one reason chronic fissures should be examined by a specialist rather than treated indefinitely with creams. Fissures in unusual positions or with unusual features are biopsied.
If you're dealing with painful bowel movements or a fissure that isn't healing, Dr. Chung can walk you through the options and help you find the right treatment for your specific situation.
Book a consultation Call (714) 988-8690Most patients return to work within a few days after non-surgical treatments. Post-surgical recovery generally allows returning to regular activities within one to two weeks.
Avoid spicy, fatty, and processed foods, as these can irritate the digestive system. Focus instead on fiber-rich fruits, vegetables, whole grains, and hydration.
If conservative treatments have not improved symptoms after several weeks, or if your fissure is severe and persistent, surgery may be recommended.
Prompt diagnosis and treatment greatly improve colorectal cancer outcomes. Call Dr. Albert Chung’s colorectal clinic in Orange County.
