Anorectal Condition
An anal fissure is a small tear in the lining of the anal canal — most often caused by a single hard or large bowel movement. The pain is sharp, distinctive, and often described as "razor-like." Many patients spend months treating it as a hemorrhoid before realizing it is something different and very specific.
The good news: most anal fissures heal with conservative, non-surgical care, and there are excellent in-office treatments for the small subset that do not. Surgery is rarely required, but it is highly effective when it is.
Most patients tell us they assumed the symptom was minor — or just something they would have to live with. Neither is usually true.
Treatment Approach
Most patients with anal fissures improve significantly with behavioral, physical, and minimally invasive treatments — long before surgery enters the conversation. Here is the full toolbox, in the order we typically work through it.
Surgery is one tool in a much larger toolbox. When we do recommend a procedure, it is because we have a specific reason — and we will explain exactly what it does, what it doesn't do, and what recovery actually looks like.
What to Expect
A comprehensive first evaluation with Dr. Johnson. Time to be listened to. In-office diagnostics when possible.
Dr. Johnson has read your intake before you walk in. The conversation starts with the impact on your life — not the textbook.
Performed with explanation at every step. Nothing happens without your full awareness and consent.
Diagnostics are performed in-office where possible to avoid extra appointments.
Every option explained. Pros, cons, and what each one would mean for your week, your work, and your life.
A Patient Story
I had been treating it as a hemorrhoid for six months. One visit, the right diagnosis, two weeks of topical treatment and it was gone. I should have come sooner.
— J.M., treated for chronic anal fissure
Frequently Asked
Pain is the giveaway. Internal hemorrhoids rarely cause significant pain. A sharp, “razor-like” pain during and after a bowel movement is much more likely to be a fissure. The honest answer is: I can tell in about thirty seconds of examination. A lot of patients waste months treating the wrong thing.
— Lisa L. Johnson, M.D., U.R.P.S.
Acute fissures often do, with stool softening and sitz baths. Chronic fissures — meaning a fissure that has been present for six weeks or more — usually need more directed treatment because the cycle of sphincter spasm prevents healing. Both respond well to care.
— Lisa L. Johnson, M.D., U.R.P.S.
For chronic fissures, often yes. It works by improving blood flow and reducing sphincter spasm. The most common side effect is a headache, which we manage proactively. For patients who can't tolerate it, calcium channel blocker ointment is a comparable option.
— Lisa L. Johnson, M.D., U.R.P.S.
Probably not. The vast majority of fissures heal with conservative or in-office care. Surgery (lateral sphincterotomy) is reserved for chronic fissures that have failed everything else. When it is the right tool, it is very effective — and we discuss the considerations carefully before recommending it.
— Lisa L. Johnson, M.D., U.R.P.S.
Almost always because the underlying cause — usually constipation or a tight sphincter — has not been addressed. A fissure that is treated topically but not preventively will often recur. The full plan addresses bowel habits, diet, and sphincter dynamics, not just the wound itself.
— Lisa L. Johnson, M.D., U.R.P.S.
A thorough, unhurried evaluation with Dr. Johnson. You will leave with a written plan — and clarity on what anal fissures is doing in your body, and what to do about it.
