Anal fissure guides by colorectal surgeons
Every guide answers one real question about anal fissures, starts with the short answer and ends with the sources we used. Pick a topic or start with the creams.
Creams and ointments
Which cream or ointment actually helps a fissure close, how to use it and what to expect.
Which anal fissure cream actually works? A surgeon’s guide by fissure type
Sphincter-relaxing ointments (nifedipine, diltiazem, nitroglycerin) are the creams that close fissures; soft stools and sitz baths make them work. Anesthetic, hemorrhoid and steroid creams only relieve symptoms, and steroids should not be used for more than 7 days.
Over-the-counter fissure creams compared: what each ingredient can and cannot do
Over-the-counter fissure creams fall into five groups: anesthetics, barrier creams, low-strength steroids, hemorrhoid combinations and "natural" ointments. They relieve symptoms of a new fissure, but only prescription sphincter relaxants have evidence for closing a chronic one.
Nifedipine cream for anal fissure: dose, application, side effects and the 8-week plan
Topical nifedipine (0.2–0.3 %, often with lidocaine) is a first-line sphincter relaxant for chronic anal fissure, used 2–3 times a day for 6–8 weeks. It heals as often as nitroglycerin with fewer headaches; most failures come from stopping early or hard stools.
Diltiazem 2% cream for anal fissure: who it is for, how to use it and what to expect
Diltiazem 2 % cream relaxes the internal sphincter and is a first-line option for chronic anal fissure, used 2–3 times a day for 6–8 weeks. A review of 7 trials found it as effective as nitroglycerin with fewer headaches (RR 0.39) and fewer recurrences (RR 0.68).
Nitroglycerin ointment for anal fissure: does it work, and can you live with the headache?
Nitroglycerin (glyceryl trinitrate) ointment is a first-line, guideline-backed cream for chronic anal fissure, sold as Rectiv in the US and Rectogesic in the UK and Australia. It heals modestly, often recurs and gives headache in up to half of users; diltiazem and nifedipine match it with fewer headaches.
Nifedipine, diltiazem or nitroglycerin: which fissure ointment should you choose?
The three sphincter-relaxing ointments heal chronic anal fissures about equally well; the choice depends on side effects, your other medicines and what is available where you live. Most colorectal surgeons now start with nifedipine or diltiazem and keep nitroglycerin as an alternative.
Understanding the fissure
What a fissure is, how it differs from hemorrhoids, and the symptoms that matter.
What is an anal fissure? A surgeon explains it with a drawing of the anal canal
An anal fissure is a tear in the thin skin of the anal canal, kept open by a spasm of the internal sphincter that reduces blood flow to the wound. Soft stools heal most new fissures; chronic ones need a sphincter-relaxing ointment and, if that fails, a procedure.
Acute or chronic anal fissure? What changes after 6 to 8 weeks
The 6 to 8 week line separates fissures that usually heal with simple care from those held open by a fixed sphincter spasm and scar tissue. Chronic fissures need a sphincter-relaxing ointment for 6 to 8 weeks first, then botulinum toxin or sphincterotomy if it fails.
Anal fissure symptoms: a 2-minute self-check
A fissure announces itself with cutting pain during the bowel movement, pain that lingers afterwards and a little bright red blood. This self-check helps you read your symptoms, spot the ones that point elsewhere and know when to see a doctor without delay.
Fissure or hemorrhoids? The pain rule that tells them apart
A fissure is a tear that hurts with every stool; hemorrhoids are swollen cushions that mostly bleed, itch or prolapse without pain. The pain rule, the type of bleeding and the kind of lump separate them, and the difference decides which treatment actually works.
Fissure, fistula or abscess? How to tell them apart
Fissure, abscess and fistula sit in the same place but are different problems: a tear, an infection and a tunnel. Pain pattern, discharge and fever tell them apart, and an abscess is the one that cannot wait.
Sentinel pile: what is the lump next to a chronic anal fissure?
A sentinel pile is the skin tag that grows at the outer edge of a chronic fissure; it marks the tear, it does not cause it. Treat the fissure first: the tag often shrinks once the tear heals, and if it is removed, it is usually during fissure surgery rather than on its own.
This content is educational and does not replace a medical consultation. FISURIN is a magistral (compounded) formula prepared under prescription in an authorized pharmacy; availability and regulatory status vary by country. If you have bleeding that does not stop, fever, or pain that worsens, seek medical care without delay.