1. Softer stools and topical treatment
Measures to make stools softer so bowel movements hurt less, together with a treatment applied to the area. This is the first step in every case.
Reviewed by Dr. Patricia Tejedor · Updated: October 23, 2026
Coloproctology Madrid
Anal fissure: treatment in Madrid
Most fissures heal without surgery. We start with the simplest option and only move to the next step if the fissure does not heal.
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Clinical summary
An anal fissure causes very sharp pain when passing stools that can last for hours. Treatment is step by step: first softer stools and topical treatment; if the fissure becomes chronic, botulinum toxin under sedation; and surgery only for cases that do not respond. The aim is to relieve pain, heal the fissure and preserve continence.
Symptoms of anal fissure
The typical symptom is very sharp pain during bowel movements, which can go on for hours afterwards. Sometimes there is a little bright red bleeding, and it often appears in people with constipation.
Bleeding and anal pain can also be caused by other conditions, such as hemorrhoids. That is why it is worth having a specialist assess it before starting treatment on your own.
How it is diagnosed
Diagnosis is usually clinical: the history and an examination in the clinic are normally enough. The examination also shows whether the fissure is recent or has become chronic, which changes the treatment.
Step-by-step treatment
Each step is only used if the previous one has not been enough.
2. Botulinum toxin
If the fissure becomes chronic or does not heal, botulinum toxin is injected under sedation, with no hospital stay, and you can go back to work the same day.
3. Surgery
Only for refractory cases, those that do not respond to the previous steps.
At every step we aim for the same thing: relieving pain, getting the fissure to heal and preserving continence.
Our team
Who will see you
Dr. Patricia Tejedor
Colorectal surgeon
View doctor: Dr. Patricia TejedorFellow of the European Board of Surgery in Coloproctology (FEBS). She sees patients at Hospital Memorial Publio Cordón, in Pozuelo de Alarcón (Madrid).
Frequently asked questions about anal fissure
Can an anal fissure heal without surgery?
In most cases, yes. Treatment starts with softer stools and topical treatment, and surgery is kept for fissures that do not respond to anything else.
Why does it hurt so much?
It is a wound in a very sensitive area that reopens with every bowel movement. That is why the pain is sharp, very intense, and can last for hours after going to the toilet.
What is botulinum toxin treatment?
It is the next step when the fissure becomes chronic or does not heal with the initial measures. Botulinum toxin is injected under sedation, with no hospital stay, and you can go back to work the same day.
Does surgery affect continence?
Preserving continence is one of the aims of treatment, and it is the reason surgery is kept only for refractory cases. At the consultation we explain which technique is proposed in your case.
How do I know if it is a fissure or hemorrhoids?
They can cause similar symptoms, such as bleeding and discomfort. Sharp, intense pain when passing stools is more typical of a fissure, but an examination is needed to know for sure.
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