What a fissure actually is.
An anal fissure is a small linear tear in the anoderm — the thin, sensitive lining at the opening of the anal canal. Most fissures are caused by passing a hard or large stool, but they can also follow childbirth, prolonged diarrhea, or any trauma to the area.
Fissures are some of the most painful conditions in proctology relative to their size. The pain typically peaks during a bowel movement and continues for one to several hours afterward — patients often describe it as a tearing or cutting sensation. Bright red blood on the toilet paper or in the bowl is common.
What makes fissures stubborn is a vicious cycle: pain causes the internal sphincter to spasm, which reduces blood flow to the area, which prevents healing. Breaking that cycle is the entire goal of treatment.
How Dr. Maz approaches treatment.
Step 1 — Stool softening and protection
Step 2 — Sphincter relaxation
Step 3 — Sitz baths and topical care
If the fissure becomes chronic
Fissures that haven't healed after 8 weeks of conservative treatment are considered chronic. Options include botulinum toxin injection (relaxes the sphincter for several months while the fissure heals) or, in rare cases, lateral internal sphincterotomy — a small precise surgery that nearly always cures the problem.
Why fissures get misdiagnosed.
Fissure symptoms — anal pain, bright red blood — are nearly identical to a thrombosed external hemorrhoid. Many patients spend months being treated for hemorrhoids before someone looks closely enough to find the fissure. A focused exam usually identifies the problem in under a minute.
"I had a Fistula caused by a fissure inside that another doctor didn't take care of properly. Dr. Ghodsian did amazing work — I finally feel like I have my life back." — Patient, fissure and fistula care
Untreated fissures can also progress to fistulas (abnormal tracts that form after chronic infection), which are more complex to fix. Catching a fissure early matters.
Common questions.
How long until the pain stops?
Most patients experiece immediate relief after the first treatment inside the office.
Will I need surgery?
Probably not. The vast majority of fissures heal with topical and behavioral treatment alone. Surgery is reserved for chronic fissures that haven't responded to a full course of conservative care.
Can fissures come back?
Yes — especially without addressing the underlying cause (usually constipation or hard stools). Long-term prevention is part of the treatment plan, not an afterthought.