At a glance
Lidocaine is a local anaesthetic that can provide temporary pain relief for anal fissure symptoms. It does not heal the fissure, but it can make bowel movements more manageable and reduce pain during acute episodes. This guide covers how it is used practically.
What lidocaine does
Lidocaine blocks nerve signals in the area where it is applied. This temporarily numbs the tissue, reducing or eliminating pain. For fissure management, this means:
- Less pain during bowel movements if applied beforehand
- Reduced post-bowel-movement burning
- More comfortable application of other topical treatments
- Pain relief at night or during flare-ups
What lidocaine does not do
- It does not relax the sphincter muscle
- It does not increase blood flow to the fissure
- It does not promote healing
- It does not address the underlying cause
Lidocaine is a symptomatic treatment — it manages pain but not the condition itself.
Available forms
Gel
The most commonly used form for fissure pain. Applied to the anal margin with a clean finger. Provides a thin, even coating that absorbs into the tissue.
Cream or ointment
Similar application to gel. Some people find the ointment base more soothing as it also provides a mild barrier effect.
Suppositories
Inserted into the anal canal. These can provide numbness further inside, which may be helpful for pain that is felt internally. Available by prescription in most cases.
Sprays
Some lidocaine products come in spray form. Less commonly used for fissures but can be helpful for people who find direct application painful.
How to use it
Before a bowel movement
Apply lidocaine to the anal margin 10 to 15 minutes before you expect to have a bowel movement. This allows the numbness to develop before the stool passes over the fissure.
After a bowel movement
Apply after cleaning and drying the area. This helps manage the post-bowel-movement pain that can last for minutes to hours.
Before other topical treatments
If applying GTN or diltiazem is painful, a thin layer of lidocaine applied five to ten minutes beforehand can numb the area enough to make the application more comfortable.
At night
Applied before bed to reduce night-time discomfort.
Practical considerations
- Do not exceed the recommended dose — lidocaine can be absorbed through the skin, and excessive use can cause systemic effects
- Keep the area clean before application
- Use as part of a broader approach — lidocaine alongside stool management, sitz baths, and healing-focused treatments
- Short-term use — lidocaine is best used for pain management during acute periods rather than as a permanent daily treatment