Managing intense fissure pain

Published 13 March 2026 ·Last reviewed 13 March 2026 by the editorial team ·How we create our content

At a glance

Fissure pain can be extraordinary. People describe it as one of the worst pains they have experienced — sharp, burning, and relentless. This guide is for people in the thick of it, who need practical strategies for managing the pain right now.

Understanding the pain

The pattern

Fissure pain follows a characteristic cycle:

  1. During the bowel movement — sharp, tearing pain as stool passes over the tear
  2. Immediately after — a brief period of relief in some people, or immediate transition to burning
  3. The spasm phase — the internal sphincter clamps down in response to the pain, causing deep, throbbing, burning discomfort
  4. Gradual easing — the spasm eventually relaxes and the pain fades. This can take 30 minutes, an hour, or several hours

The spasm phase is typically the worst part. It is also the phase where intervention can make the biggest difference.

Why it is so intense

The anal canal has a rich nerve supply. The combination of a physical tear being repeatedly aggravated, plus sustained muscle spasm that reduces blood flow to the area, creates a pain experience that is disproportionate to the size of the wound. A fissure may be small, but the pain it generates is anything but.

Immediate pain management

Warm sitz bath

This is the single most effective immediate measure. People describe it as going from a pain level of eight or nine to a four or five within minutes.

  • Fill a basin or bathtub with comfortably warm water
  • Sit in it immediately after a bowel movement
  • Stay for 10 to 15 minutes
  • The warmth relaxes the sphincter and interrupts the spasm cycle

If you do not have a sitz bath set up, a warm shower directed at the area can help, though it is not as effective as soaking.

Breathing

Deliberate, slow breathing during and after bowel movements helps in two ways: it reduces the overall tension in the body, and it specifically helps relax the pelvic floor and sphincter.

  • Breathe in slowly through the nose
  • Breathe out slowly through the mouth, letting the belly expand and the pelvic floor relax
  • Focus on releasing tension with each exhale

Pain medication

  • Paracetamol — taken 30 to 60 minutes before an expected bowel movement can take the edge off
  • Anti-inflammatory medication (ibuprofen, if appropriate for you) — can help with the inflammation component
  • Topical anaesthetic — some over-the-counter products provide temporary numbing. These provide short-term relief but do not address the underlying problem
  • Prescribed topical treatments — GTN or diltiazem work by relaxing the sphincter muscle, which addresses the spasm that drives the pain

Positioning

After a bowel movement, lying on your side with knees slightly bent can be more comfortable than sitting. Some people find that walking gently helps — the movement can distract from the pain and may help the spasm resolve faster.

Reducing pain over time

The immediate measures above manage individual episodes. Reducing the overall intensity of fissure pain over time requires addressing the root causes:

Softer stools

Every hard stool re-traumatises the fissure. Soft stools dramatically reduce the tearing component of the pain. Fibre, water, and stool softeners are the foundation.

Breaking the spasm cycle

Prescribed topical treatments (GTN, diltiazem) work specifically on sphincter relaxation. If you are not on one of these and your pain is significant, discuss this with your GP or specialist.

Healing the fissure

As the fissure heals, the pain diminishes. This is the long-term goal. Everything else — sitz baths, medication, breathing — is about managing the pain while healing happens.

When pain signals a problem

Fissure pain is expected to gradually improve over weeks of consistent care. If:

  • Pain is getting worse rather than better
  • New symptoms develop alongside the pain
  • The pain is not responding to the measures above
  • You are unable to function because of the pain level

These are signals to revisit your treatment plan with your clinician. More aggressive treatment — botox injection, surgical options — may be appropriate.

Common questions

Why does fissure pain last so long after a bowel movement?

The pain pattern of a fissure is distinctive: sharp pain during the bowel movement, followed by a burning or throbbing that can last minutes to hours. This is caused by sphincter spasm — the muscle clamps down in response to the tear, reducing blood flow and causing sustained pain. This spasm is the main driver of post-bowel-movement pain.

What provides the fastest pain relief?

People consistently describe warm sitz baths as the most reliable fast-acting relief. The warm water relaxes the sphincter, increases blood flow, and interrupts the spasm cycle. Sitting in a warm bath immediately after a bowel movement can significantly reduce the duration of the pain episode.

Is it normal for fissure pain to make you cry?

Yes. Many people describe fissure pain as severe enough to bring them to tears. The combination of sharp tearing pain followed by sustained burning is genuinely intense. If your pain is this severe, it is worth discussing with your clinician — both for adequate pain management and to ensure the treatment plan is appropriate for the severity of your condition.

Can I take strong painkillers for fissure pain?

Paracetamol is generally the recommended baseline pain relief. Anti-inflammatory medications may also help. Opioid painkillers are generally avoided because they cause constipation, which makes the fissure worse. If your pain is not adequately managed with standard options, discuss this with your clinician — there may be topical or procedural options that can help.

When to seek care Heavy bleeding or feeling faint? Get emergency help now. Emergency: 911

Not sure how urgent it is? Get help today.

  1. Emergency

    Heavy bleeding, black tarry stools, feeling faint, severe pain or trouble breathing.

    Call 911 or go to the ER.

  2. Today

    Fever, pain getting worse, a hot swollen lump, or trouble passing urine.

    Call your doctor or go to urgent care.

  3. Soon

    Bleeding or bowel changes nobody has checked, or anything lasting 3 weeks.

    Book a doctor’s appointment.

Feeling overwhelmed? Call or text 988, any time.

See all the signs

For this topic, get medical advice if you notice:

  • Rectal bleeding — always worth getting checked
  • Unexplained weight loss
  • Persistent change in bowel habits
  • Severe or worsening pain

Recording how you feel is not the same as being checked. These are the signs that need a doctor’s attention.

Call 911 or go to the emergency room now if you have:

  • bleeding that will not stop, a lot of blood (the toilet water turns red, or you pass large clots), or any bleeding with feeling faint or dizzy
  • fainting, a racing heart or trouble breathing
  • confusion or slurred speech, extreme shivering, no urine in a day, or blotchy skin
  • sudden severe belly pain, or a swollen, hard belly with vomiting or not passing stool or gas
  • you cannot pass urine at all, or your bladder feels full and painful and you can’t empty it
  • redness, swelling or severe pain spreading quickly around your anus, genitals or groin, especially with a fever or feeling very ill
  • a fever with a painful swelling near your anus if you have diabetes or a weakened immune system (for example, from chemotherapy or transplant medicines)
  • black, tarry stools

Call your doctor or go to urgent care today (or the ER if you can’t be seen today) if you have:

  • a temperature of 100.4°F (38°C) or higher, chills, vomiting, or feeling generally unwell
  • pain that is getting worse over days, or severe pain that stops you sitting or sleeping
  • a hot, swollen or very tender lump near your anus or at the top of the crease between your buttocks, or foul-smelling discharge
  • trouble urinating
  • bleeding that is getting heavier or more frequent, or blood mixed into your stool
  • feeling much more tired than usual, looking pale, or getting out of breath more easily than you used to
  • not passing stool for several days, or new belly pain

Make an appointment with your doctor if:

  • you have never had these symptoms checked by a doctor or nurse — whatever your age
  • you have had rectal bleeding for more than 3 weeks
  • your bowel movements have been looser, thinner or more frequent than usual for 3 weeks or more, or you have lost weight without trying
  • symptoms have not settled after a week or so, or keep coming back
  • you notice a new lump near your anus, between your buttocks or in your belly, or an itch or discharge that does not clear
  • you have new leakage or trouble controlling your bowels
  • you are 45 or over, or have a family history of bowel cancer or inflammatory bowel disease, and any of these symptoms are new for you

If you are unsure, it is always reasonable to ask. If things feel overwhelming, call or text 988 (Suicide & Crisis Lifeline) or chat at 988lifeline.org, any time. If you don’t feel safe, call 911.

Showing US care routes. Change region at the foot of the page.

Discreet symptom tracking

Symptoms that come and go? Keep track, day by day.

For hemorrhoids, fissures, fistulas and other anal and rectal problems. A short, discreet email asks how things have been, and saves each answer, so you can look back at every flare and every good week in your own words. If you haven’t had your symptoms checked, see your doctor first.

  • About ten seconds a check-in. No app, no password.
  • Nothing in the subject or preview says what it’s about.
  • Each Sunday, a link to your week, ready for your next appointment.
Start tracking →

Your notes

Your check-in

Takes about ten seconds.

20:00
Example. Nothing on the lock screen hints at symptoms or conditions.

Explore more

Related guides

Anal fissures: patterns and care

Learn what an anal fissure is, what people commonly experience, what tends to help, and when to seek medical care.

Sphincter relaxation techniques

Non-surgical approaches to relaxing the internal anal sphincter — sitz baths, breathing, warm compresses, and what people report about reducing spasm.

Sitz bath routine: tips and mistakes

A practical guide to sitz baths based on what people commonly report about routines, timing, temperature, and what to avoid.

Related experiences

Acute fissure: sharp pain after BMs

A composite experience of the first weeks living with acute fissure symptoms — what people commonly report, what they try, and when they seek care.

Chronic fissure treatment journey

A composite account of the path people describe from an acute fissure that does not heal into the world of chronic fissure treatment options.