At a glance
Anal fissures after forceps or instrumental delivery are remarkably common — yet they are rarely discussed during antenatal preparation. The combination of perineal trauma, postpartum constipation, and the physical demands of labour creates a perfect environment for fissures to develop.
If you are dealing with this, you are not alone. Many people find themselves managing sharp anal pain alongside the already overwhelming experience of caring for a newborn. This page covers why it happens, what helps, treatment considerations while breastfeeding, and when a fissure may need more than conservative care.
Why forceps delivery increases fissure risk
Instrumental delivery — including forceps and ventouse (vacuum) — involves significant pressure and stretching of the perineal and anal area. Several factors combine:
- Direct trauma — the physical force involved in an assisted delivery can strain or injure the anal area, even if the perineal tear itself is managed
- Pelvic floor impact — instrumental delivery can affect the pelvic floor muscles, including the anal sphincter, altering how they function during bowel movements
- Severe postpartum constipation — fear of the first bowel movement after delivery, dehydration from labour, hormonal shifts, and pain medication all contribute to harder stools
- Iron supplements — commonly prescribed postpartum, these are well known to cause constipation
- Perineal stitches — the presence of stitches can make people tense the entire pelvic floor area during bowel movements, increasing pressure on the anal canal
- Exhaustion — sleep deprivation and the demands of a newborn make it harder to maintain the self-care routines that support healing
People often describe the fissure developing within the first week or two postpartum, sometimes with the very first bowel movement after delivery.
The challenge of managing a fissure with a newborn
This is the part that makes postpartum fissures uniquely difficult. People describe:
- Being in severe pain during and after bowel movements while also needing to care for a baby
- Difficulty finding time for sitz baths when feeding and settling a newborn
- Putting off their own care because the baby’s needs feel more urgent
- Feeling that nobody warned them this could happen
- Struggling to sit comfortably while breastfeeding
The most consistent piece of advice from people who have been through it: prioritise your own care alongside the baby’s. A fissure that is not managed early can become chronic, which is harder to treat later.
What helps
The fundamentals
- Fibre and hydration — soft stools are the single most important factor in fissure healing. Increasing fibre through food or supplements and drinking plenty of water is generally safe while breastfeeding.
- Stool softeners — many postpartum people are already prescribed these. If not, ask your midwife or doctor. Keeping stools soft reduces the trauma to the fissure with each bowel movement.
- Sitz baths — warm water soaks after bowel movements provide pain relief and support healing. Even 5 to 10 minutes helps. Some people use a sitz bath basin that fits over the toilet so they can manage it more easily.
- Responding to the urge — delaying bowel movements allows stools to harden further, making things worse.
Practical strategies people describe
- Setting up a sitz bath station in the bathroom that is always ready to use
- Asking a partner or support person to hold the baby during bathroom time
- Taking stool softeners consistently, not just when constipation strikes
- Using a small step stool under the feet during bowel movements to reduce straining
- Wearing loose, comfortable clothing and using a cushion for sitting and feeding
- Keeping a water bottle within reach during feeds as a hydration reminder
Treatment while breastfeeding
This is where things get complicated. Some topical treatments commonly used for fissures — such as GTN ointment and diltiazem cream — have limited safety data during breastfeeding. This does not necessarily mean they are unsafe, but it does mean any treatment should be discussed with your doctor or midwife first.
What is generally considered safe during breastfeeding:
- Fibre supplements
- Stool softeners (most types)
- Sitz baths
- Barrier creams and basic wound care
What needs a conversation with your doctor:
- Prescription topical treatments (GTN, diltiazem, nifedipine)
- Any oral medication for pain or healing
- Procedures such as Botox injection or surgery, if the fissure becomes chronic
Your doctor can weigh the benefits and risks for your specific situation and help you find a treatment approach that works.
When a postpartum fissure becomes chronic
Most postpartum fissures heal with conservative care within a few weeks. But some do not. A fissure is generally considered chronic when it has not healed after 6 to 8 weeks of consistent treatment.
Signs that a postpartum fissure may be becoming chronic:
- Pain that has not improved despite consistent fibre, hydration, and stool management
- A visible sentinel pile (a small tag of skin near the fissure)
- Pain that follows every bowel movement, sometimes lasting hours
- A pattern of partial healing followed by re-tearing
If your fissure is not healing, ask for a referral to a colorectal specialist. Chronic fissures have additional treatment options — including prescription topical treatments and, if needed, procedures — that can break the cycle. Being postpartum does not mean you have to simply endure the pain.
You deserve care too
Postpartum health conversations tend to focus on the baby, the perineum, and mental health. Anal fissures rarely get mentioned. But they are common, they are treatable, and you deserve the same attention for your own pain as your baby receives for theirs.
If your midwife or doctor has not asked about bowel symptoms, raise it yourself. You can say something like: “I have been having a lot of pain with bowel movements since delivery. Can we talk about it?” That is enough to start the conversation.
When to contact your doctor
- Heavy or persistent bleeding
- Severe pain that is getting worse
- Fever or signs of infection
- Symptoms not improved after 4 to 6 weeks