An anal fissure and an anal fistula might sound similar because of their names. Although both affect the area around the anus, they are distinct conditions with different causes, symptoms and treatments.
If you or someone you care about has symptoms in this area, how can you tell whether it’s a fissure or a fistula? At Banner Health, our experts carefully evaluate your condition and create personalized treatment plans to reduce pain, promote healing and prevent complications.
An anal fissure is a small tear or crack in the lining of the anus. Anal fissures are common and may be acute (short-term) or chronic (lasting longer than six weeks).
Fissures are most often caused by:
Even a small tear can cause sharp pain, burning or itching, especially during a bowel movement. You may notice a small amount of bright red blood on the toilet paper when you wipe.
An anal fistula is a small tunnel that forms between the inside of the anus or rectum and the skin outside the anus. Fistulas can develop between the anus and the skin, the anus and the vagina or the skin and part of the intestine.
Most anal fistulas develop after an abscess. An abscess is a pocket of infection that does not fully heal. When the abscess drains, it can leave a tunnel behind. Other causes may include:
Symptoms may include:
Learn more about different types of fistulas.
Here is a quick guide to help distinguish between the two conditions.
Anal fissure:
Anal fistula:
Your health care provider will use a combination of your medical history, a physical exam and sometimes imaging tests to make a diagnosis.
Your provider may ask about:
A close look at the anal area can identify tears, openings or swelling. If a fistula is suspected, your provider will check for the external opening and signs of infection.
Sometimes additional tests are needed, including:
Getting an accurate diagnosis will help guide your treatment plan.
Treatment depends on the condition and its severity.
Many fissures heal with non-surgical care:
If a fissure does not heal, additional options include:
Anal fistulas usually require surgery performed by a colorectal surgeon. The type of procedure depends on the location and depth of the fistula. If your fistula is caused by IBS and isn’t infected, your surgeon might try medicine that helps your immune system (immunomodulators) before doing surgery.
Surgical options include:
Recovery may take several weeks to a few months. During healing, you can reduce discomfort by:
These practices can support healing and reduce inflammation.
Contact your health care provider if you have:
Early evaluation can prevent complications.
Without treatment, symptoms may worsen. Untreated anal fissures can become chronic. Pain may continue and healing becomes more difficult. Chronic fissures often require medication or minor surgery.
Untreated anal fissures rarely heal on their own. Infection can return, abscesses might form again and drainage can continue. Delaying treatment may lead to a more complex condition that requires more advanced surgery.
Some discomfort is normal after surgery but pain improves as you heal. Your health care provider will give you medication and care instructions.
Colorectal surgeons use techniques designed to protect the muscles that control bowel movements.
Yes, both conditions can return, especially if constipation, infection or IBD is not controlled. Follow-up care reduces the risk of returning fissures or fistulas.
You can reduce your risk by eating plenty of fiber, drinking plenty of water, avoiding straining when you have a bowel movement and treating infections early.
At Banner Health, our colorectal specialists provide expert diagnosis and advanced treatment for anal fissures and anal fistulas. We use evidence-based techniques and personalized care plans to reduce pain, support healing and improve long-term outcomes.
If you are experiencing symptoms, schedule an appointment with a Banner Health specialist.
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