At a glance
People sometimes describe a cut, crack, or wound that appears between the buttock cheeks — in the natal cleft — and wonder whether it is an anal fissure. While the discomfort can be similar, the location and cause are usually different from a true anal fissure.
This guide covers the common causes of wounds in this area and how to distinguish them from anal fissures.
Anal fissure versus natal cleft wound
The distinction is important because the causes and treatments differ:
Anal fissure
- Located in the anal canal — at or just inside the anal opening
- Pain is primarily triggered by bowel movements
- Caused by tearing of the anal lining, typically from hard stools
- Treated with stool softening, sitz baths, sphincter relaxation, and sometimes medication or surgery
Natal cleft wound
- Located higher up, in the groove between the buttock cheeks
- Pain may be constant or triggered by movement and friction rather than bowel movements
- Caused by skin breakdown from moisture, friction, infection, or skin conditions
- Treated by addressing the underlying cause — moisture management, antifungal treatment, or medical assessment for pilonidal disease
Common causes of natal cleft wounds
Intertrigo (moisture-related skin breakdown)
The most common cause. The natal cleft is a skin fold that traps moisture and warmth. When sweat or moisture sits against the skin for extended periods, the skin becomes macerated (softened and weakened) and eventually breaks down. This creates a raw, painful area that can look like a cut.
What helps:
- Keeping the area clean and dry
- Using a barrier cream (zinc oxide) to protect the skin
- Wearing breathable cotton underwear
- Drying the area thoroughly after washing
- Changing out of sweaty clothing promptly
Fungal infection
The warm, moist environment of the natal cleft is ideal for fungal growth. Fungal infection in this area (often candida) causes redness, itching, and skin breakdown that can include cracking.
What helps:
- Antifungal cream — available over the counter in most pharmacies
- Keeping the area dry
- If it does not improve within one to two weeks, a clinician can assess and prescribe a stronger treatment
Friction
Physical activity, particularly walking or running, can cause friction between the buttock cheeks that leads to skin irritation and cracking.
What helps:
- Anti-chafing products or barrier cream before exercise
- Moisture-wicking clothing
- Reducing friction with appropriate underwear
Pilonidal disease
A wound in the upper natal cleft — particularly near the tailbone — could be related to a pilonidal sinus or cyst. This involves hair follicles becoming trapped under the skin, leading to infection and abscess formation.
Signs that suggest pilonidal disease:
- The wound is near the top of the natal cleft, close to the tailbone
- Recurrent episodes of swelling and drainage
- A small pit or opening visible in the skin
Pilonidal disease requires medical assessment and often surgical treatment.
Skin conditions
Eczema, psoriasis, and other skin conditions can affect the natal cleft. These typically cause broader redness, scaling, and itching alongside any skin breakdown.
When to see a clinician
A wound between the buttock cheeks that is:
- Not improving after one to two weeks of basic skin care
- Getting worse — deeper, more painful, or showing signs of infection
- Recurrent — happening repeatedly in the same area
- Associated with swelling, pus, or fever
- Causing significant pain or affecting daily activities
These are all reasons for clinical assessment. A brief examination can determine the cause and guide appropriate treatment.