What Does Rectal Fissures Look Like?

A rectal fissure is a small tear in the thin, moist tissue that lines the anus. Most people describe it as looking like a paper cut or a crack in the skin. It is usually located right at the opening of the anus, and it often appears as a red or pinkish linear split that may be difficult to see without gently spreading the buttocks apart.

Because the area is highly sensitive, identifying a fissure is often based on symptoms as much as appearance. The classic signs are sharp pain during bowel movements and bright red blood on the toilet paper. While the tear itself is small—usually less than a centimeter long—it can cause significant discomfort that lasts for hours after a bowel movement.

What Does a Rectal Fissure Actually Look Like?

A rectal fissure looks like a shallow, elongated cut in the anal lining. In its early stage, it appears as a fresh red crack, similar to chapped lips. The edges are typically soft and smooth. When you gently separate the buttocks, you may see the tear at the 12 o’clock or 6 o’clock position—the front or back of the anal opening.

If the fissure has been present for more than six weeks, it is considered chronic. A chronic fissure looks different. The edges become raised and firm, and a small skin tag, called a sentinel tag, may develop at the lower end of the tear. The base of the fissure may show the pale fibers of the internal anal sphincter muscle, which gives it a slightly whitish appearance.

Most fissures are too small to photograph easily, and they are often hidden within the folds of the anus. This is why doctors rarely rely on sight alone. They use the history of pain and bleeding, along with a careful physical exam, to make the diagnosis.

What Causes a Fissure to Form?

The most common cause is passing a hard or large stool. The stretching of the anal canal tears the delicate lining. Constipation is the leading trigger, but diarrhea can also cause fissures because frequent loose stools irritate and inflame the anal tissue.

Childbirth is another common cause. The pressure of delivery can tear the anal lining, and many women develop fissures in the weeks after giving birth. Other causes include prolonged sitting on hard surfaces, heavy lifting, and anal intercourse.

In some cases, a fissure forms without any clear cause. This is more concerning because it may signal an underlying condition. Crohn’s disease, ulcerative colitis, and certain infections can all produce fissures that are unusual in location or slow to heal. A fissure that appears off-center—not at the 6 or 12 o’clock position—should raise suspicion for another condition.

How Can You Tell a Fissure from a Hemorrhoid?

This is a common point of confusion, and the two conditions often get mixed up. Fissures and hemorrhoids both cause bleeding, but they feel different. A fissure produces sharp, tearing pain during a bowel movement. A hemorrhoid usually causes a dull ache, itching, or a feeling of fullness, but not sharp pain with stool passage.

Visually, the difference is also clear. A fissure is a flat tear or crack in the tissue. A hemorrhoid is a swollen, bulging vein that looks like a small grape or a lump. External hemorrhoids are visible at the rim of the anus as bluish-purple bumps. Internal hemorrhoids are not visible from the outside unless they prolapse and protrude through the opening.

Bleeding patterns differ too. Fissure bleeding is usually bright red and small in amount—often just a streak on the toilet paper. Hemorrhoid bleeding can be heavier, and you may see blood in the toilet bowl or streaked on the stool itself.

When Should You See a Doctor?

Any rectal bleeding should be evaluated by a healthcare professional. While fissures are common and usually benign, bleeding can also signal more serious conditions, including colorectal cancer. The American Cancer Society notes that blood in the stool is a potential warning sign that should never be dismissed.

You should especially seek medical attention if the pain is severe, if bleeding persists for more than a few days, or if you notice a change in bowel habits. A fissure that does not heal after six to eight weeks of home treatment requires professional care. A doctor can confirm the diagnosis with a simple exam, which is usually quick and uncomfortable but not painful.

In some cases, a doctor may recommend an anoscopy or sigmoidoscopy. These procedures use a small scope to look inside the anal canal and lower rectum. They help rule out other causes of bleeding and check for signs of inflammatory bowel disease.

What Are the Treatment Options?

Most fissures heal on their own with conservative measures. The goal is to soften the stool and reduce pressure on the anal canal. Increasing fiber intake to 25 to 30 grams per day is a well-established first step. Drinking plenty of water and using a stool softener like docusate sodium can also help prevent painful bowel movements.

Sitz baths are a standard home remedy. Sitting in warm water for 10 to 15 minutes, two to three times a day, relaxes the anal sphincter and increases blood flow to the area. This promotes healing and reduces pain. The water should be comfortably warm, not hot.

Topical ointments containing lidocaine can numb the area and ease discomfort. Some creams contain nitroglycerin or nifedipine, which work by relaxing the sphincter muscle. These require a prescription and can cause headaches as a side effect. Over-the-counter hydrocortisone creams reduce inflammation but should not be used for more than a week without medical supervision.

For chronic fissures that do not respond to home care, a doctor may recommend botulinum toxin injections. This treatment temporarily paralyzes the sphincter muscle, allowing blood flow to return to the fissure. Surgery, called lateral internal sphincterotomy, is reserved for severe cases. It has a high success rate but carries a small risk of incontinence, which is why it is not a first-line option.

Can Fissures Be Prevented?

Prevention focuses on keeping stools soft and regular. A diet rich in fruits, vegetables, and whole grains is the most effective strategy. Staying hydrated is equally important—fiber only works when you drink enough water.

Do not delay bowel movements. Waiting increases water absorption from the stool, making it harder and more likely to cause tearing. When you do use the toilet, avoid straining. Give yourself time, but do not sit for prolonged periods on the toilet, as this increases pressure on the anal area.

Regular physical activity also helps. Exercise stimulates bowel motility and reduces the time stool spends in the colon, which keeps it softer. For women who have had vaginal deliveries, pelvic floor therapy may reduce the risk of fissures, though the evidence for this is limited.

What Happens If a Fissure Goes Untreated?

Most fissures heal within four to six weeks, even without treatment. The body repairs the tear as long as the area is not repeatedly irritated. However, if constipation continues and the fissure is re-torn with each bowel movement, it can become chronic.

A chronic fissure is not dangerous in itself, but it significantly reduces quality of life. The pain can become constant, not just during bowel movements. Some people develop a fear of using the toilet, which leads to more constipation and a worsening cycle. In rare cases, a chronic fissure can become infected, though this is uncommon.

There is no evidence that untreated fissures increase the risk of colorectal cancer. However, the symptoms—bleeding and pain—overlap with more serious conditions. This is why persistent symptoms always warrant a medical evaluation, regardless of whether you suspect a fissure.