At a glance
A fissure is generally considered chronic when it has not healed after 6 to 8 weeks of conservative care. Chronic fissures tend to develop distinct features and often require treatment beyond basic self-care.
This page covers why some fissures do not heal, what changes as a fissure becomes chronic, the typical treatment escalation path, and the emotional toll people commonly describe.
Why some fissures do not heal
Not every fissure responds to initial care. People report several factors that seem to contribute to fissures becoming chronic:
- Internal sphincter spasm — the muscle around the fissure tightens, reducing blood flow to the area and slowing healing
- Repeated re-tearing — hard stools or straining can reopen the wound before it has a chance to close
- Ongoing constipation cycle — fear of pain leads to avoidance, which leads to harder stools, which re-injures the area
- Reduced blood supply — the posterior midline of the anus naturally has less blood flow, making healing harder in that location
What changes when a fissure becomes chronic
People with chronic fissures commonly describe:
- A sentinel pile — a small skin tag that forms at the outer edge of the tear
- Thickened edges around the fissure, sometimes called fibrotic margins
- Exposed internal sphincter fibers visible in the base of the wound
- Pain that becomes a predictable daily pattern tied to bowel movements
- Bleeding that may come and go but does not fully resolve
Treatment escalation
When conservative care alone is not enough, treatment typically follows a stepped path. Each step should be discussed with your doctor.
- Continued conservative care — fiber, hydration, sitz baths, stool softening. This remains the foundation at every stage.
- Prescription topical treatments — a doctor may prescribe ointments that help relax the internal sphincter and improve blood flow to the area.
- Botox injection — a procedure to temporarily relax the sphincter muscle. Many people report improvement, though repeat treatments are sometimes needed.
- LIS surgery — lateral internal sphincterotomy. A small cut to the internal sphincter to permanently reduce spasm. People often describe this as highly effective, though it carries risks that should be discussed with a surgeon.
The emotional toll
Chronic fissures affect more than the body. People commonly report:
- Anxiety about bowel movements becoming a daily burden
- Frustration when treatments do not work as quickly as expected
- Feeling isolated because the condition is difficult to talk about
- Low mood from persistent pain that interferes with daily life
- Difficulty explaining the severity to friends, family, or employers
These feelings are common and valid. Many people find it helpful to connect with others who have been through similar experiences.
What tends to help
- Staying consistent with fiber, hydration, and sitz baths even when progress feels slow
- Working with a doctor to move through treatment steps rather than waiting indefinitely
- Keeping a symptom journal to track patterns and share with your provider
- Giving each treatment adequate time to work before changing course
- Seeking emotional support — whether from a community, a therapist, or someone you trust
What tends to make things worse
- Stopping conservative care because it “isn’t working” — these habits support healing at every stage
- Waiting too long to escalate treatment when there is no improvement
- Straining or rushing bowel movements
- Ignoring the emotional impact and pushing through without support
Talking to your doctor
If your fissure has not healed after 6 to 8 weeks, it is worth discussing next steps. Helpful things to bring up:
- How long you have been managing symptoms
- What treatments you have already tried and for how long
- Whether symptoms are stable, improving, or worsening
- Any emotional impact you are experiencing
- Questions about the next treatment option and what to expect
If you experience severe pain, heavy bleeding, fever, or symptoms that concern you, seek medical care.