Why does an anal fissure take a long time to heal?

An anal fissure is a defect in the anoderm in the anal canal. An acute fissure can heal if the traumatic factors are eliminated, but repeated tissue damage and persistent sphincter spasm can impede recovery. Therefore, treatment for anal fissures is aimed not only at reducing pain but also at eliminating the conditions that are causing the defect to persist.

Why doesn't an anal fissure heal?

A common cause is repeated mechanical trauma. Hard stools during constipation further damage the anoderm during defecation. With frequent diarrhea, irritation and trauma can also perpetuate inflammation and interfere with normal tissue repair.

Spasm of the internal anal sphincter plays a significant role. The injury causes pain, which in turn increases sphincter tone. The spasm reduces blood flow to the fissure area, creating less favorable conditions for healing. The next time you defecate, the defect is re-injured.

This creates a vicious cycle: injury and pain → sphincter spasm → impaired blood supply and healing → repeated trauma during defecation. Therefore, the disappearance of pain does not necessarily mean that the cause of the condition has been eliminated.

When a crack becomes chronic

According to Russian clinical guidelines, an acute anal fissure persists for up to two months and has smooth edges without significant fibrous changes. If damaging factors persist and epithelialization does not occur, fibrous tissue gradually forms at the edges and base of the defect.

A chronic fissure is characterized by denser, altered edges; a sentinel tubercle may appear. However, the presence of any mass near the anus does not allow for such a diagnosis: similar changes are also found in other proctological conditions.

Chronicity does not necessarily require surgery. Treatment depends on the tissue condition, the severity of the spasm, the duration of the condition, and the effectiveness of conservative treatment.

Why pain may disappear and then come back

A chronic anal fissure can progress in waves. For a while, pain and bleeding may subside or disappear completely, but this doesn't always mean the defect is completely healed.

If constipation, diarrhea, or other traumatic factors persist, symptoms may recur. However, a recurrence of pain alone does not necessarily indicate that a fissure is the cause; an examination is necessary.

What to do if a crack doesn't heal for a long time

If pain, burning, or blood after bowel movements persists for a long time or returns regularly, consult a proctologist. The doctor will assess the nature of the defect, the condition of its edges, the presence of sphincter spasm, and signs of chronicity, and rule out other causes of the symptoms.

Treatment may include normalizing bowel movements, conservative methods to reduce pain, and alleviate sphincter spasm. In cases of chronic fissures and insufficient response to such therapy, minimally invasive or surgical methods are considered in some cases.

The main goal is not just to temporarily relieve pain, but to disrupt the mechanism of re-traumatization and create conditions for sustainable tissue healing.