How to Soothe Itchy Anal Fissures

Soothing itchy anal fissures involves remedying current fissures, including with a sitz bath, ointments, and more.

Most itchy anal fissures are not easily reachable, and scratching the ones you can reach is rarely subtle or soothing. But you have options for treatment. Some treatments relieve itching immediately, while others help clear up the fissures over time and relieve itching in the long term.

Read on for a roundup of the best at-home anal fissure treatment options and doctor-prescribed ones. Plus, find out when you may want to consider contacting a healthcare professional about your anal itching.

A sitz bath is essentially a pool for your patootie.

“During a sitz bath, you immerse your anus in 2 to 3 inches of warm water for 10 to 15 minutes,” says Prasun Shah, MD, a gastroenterologist with Memorial Hermann Medical Group in Houston, Texas.

Warm water helps relax the tight anal sphincter muscle and improves blood flow to the anal mucosa, which can experience damage when you have anal fissures.

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Blood is filled with nutrients, so promoting blood flow to the wounded anal canal can help promote healing, he explains.

“Sitz bath kits are available in most drugstores, but you can also use a bowl or bathtub by filling it with 2 to 3 inches of warm water,” he says.

Don’t add soap or bubble bath ingredients, as these can be irritating and increase your risk of itching or irritation.

“After a sitz bath, it’s important to pat the anal area dry,” he says. This helps keep the area from drying out, which could lead to more itchiness.

Over-the-counter (OTC) and prescription analgesic creams and gels can help relieve itching.

These medications work by relaxing the blood vessels in the anal canal, as well as relaxing the sphincter muscle, so the fissure is able to heal rather than being continuously reopened, explains Sarah J. Robbins, MD, a gastroenterologist and nutrition specialist with Well Sunday.

Common anal fissure cream medications include:

• nifedipine
• diltiazem (Dolizem)
• nitroglycerin (Nitrol)

“They need to be applied onto the skin of the anus 3 to 4 times per day for 1 to 3 months,” she says. “It’s really important to get some of the ointment inside the anal canal to relieve the muscle spasm and other symptoms.”

“When stool is particularly large or hard, it can lead to tears in the lining of the anal canal,” says Shah.

In many cases, drinking more water and increasing your dietary fiber intake can make your stools easier to pass and help protect you from future anal fissures, he says.

You may benefit from an OTC fiber supplement if you continue to have hard bowel movements despite eating a high fiber diet.

A fiber supplement can include:

• psyllium (Metamucil)
• methylcellulose (Citrucel)
• wheat dextrin (Benefiber)
• calcium polycarbophil (FiberCon)

“Fiber supplements are safe for daily use, non-habit-forming, and can be used lifelong,” he says.

“If constipation doesn’t improve with the addition of a fiber supplement, then stool softeners or laxatives are appropriate for the treatment of root cause of anal fissure,” says Shah.

Stool softeners or laxatives can include:

• docusate sodium (Dulcolax)
• mineral oil (Fleet Mineral Oil)
• polyethylene glycol (MiraLAX)
• magnesium hydroxide (Milk of Magnesia)
• bisacodyl and sennosides (Senna)

These medications help keep stool soft enough that you don’t have to strain when you’re trying to have a bowel movement, explains Robbins.

“Avoiding straining helps to ease the discomfort of the fissure and also helps to prevent further damage to the fragile skin,” says Robbins.

If none of the above anal fissure treatment options work for you, there are other treatment options available. Keep in mind that they’re typically more invasive, though, so talk with your doctor about them first.

“The most effective surgery for anal fissures is a sphincterotomy, which involves cutting the anal sphincter,” explains Shah.

However, this is usually a last-resort option because it does carry some risk of fecal incontinence — particularly for older adults and people who have given birth vaginally.

“You can also inject botulinum toxin into the anal sphincter or around the anal canal to help relax the hypertonic anal sphincter muscle and, in turn, improve healing of chronic anal fissures,” he says.

How long will anal fissure-related itching last?

Anal fissures typically start to itch when they’re reopened during the healing process.

Although anal fissures can last anywhere from a few weeks to several months, “symptoms usually just last a few days,” explains Robbins.

What other symptoms can anal fissures cause?

“Other symptoms of anal fissures include sharp pain during or after a bowel movement, bleeding after wiping, burning, and pain,” says Robbins.

What else can cause anal itching?

Many things can result in anal itching.

According to Robbins, common causes include:

• irritation due to chemicals or fragrances in soaps and detergents
• consumption and passing of spicy foods, coffee, and dairy products
• infection, such as a yeast infection or sexually transmitted infection
• hemorrhoids

What causes anal fissures?

“Anal fissures are most commonly caused by constipation,” says Shah.

When you’re constipated, hardened stool can stretch the anal mucosa beyond what its natural elasticity allows. The result? Microscopic tears up and down the canal.

Anal fissures can also be caused by persistent diarrhea, such as that which happens when an individual has an inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis, he says.

“Certain sexually transmitted infections, such as syphilis or herpes, can also infect the anal canal and lead to damage or fissures,” he says.

If the area in and around your anus and anal canal are itchy — like, really itchy — Shah recommends contacting a doctor.

“Itchiness is actually not the major symptom of anal fissure,” he says. “So, if you have itching as a main complaint, you should be evaluated by your healthcare provider or gastroenterologist to make sure there’s not another underlying issue.”

Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Austra Health, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.

Last medically reviewed on March 8, 2023