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What treatments are effective for anal fissures caused by sex?
Executive summary
Anal fissures from anal sex are treated first with conservative measures—fiber, stool softeners, sitz baths, topical anesthetic or muscle‑relaxing creams—and most acute fissures heal in days to weeks with these steps (WebMD; Merck Manual) [1] [2]. If fissures persist or become chronic, clinicians may use botulinum toxin injections or consider surgical options such as fissurectomy or lateral internal sphincterotomy, though some surgeons caution about sphincterotomy for people who engage in receptive anal intercourse because of potential sexual or continence complications [2] [3] [4].
1. Conservative first: stool softening, baths and pain relief
Front‑line care for fissures caused by trauma (including anal sex) aims to reduce further tearing and ease pain: increasing fiber and fluids, using stool softeners, warm sitz baths, and topical anesthetic (lidocaine) to numb pain while the tissue heals; many fissures resolve within a few weeks with these measures [1] [2] [5]. WebMD, Merck Manual and Cleveland Clinic describe this stepwise approach and note that acute fissures often heal without invasive treatment [1] [2] [5].
2. Medical topical therapy to relax the sphincter and promote healing
When simple measures aren’t enough, doctors commonly prescribe topical agents that reduce sphincter spasm and increase blood flow to the area—nitroglycerin ointment or topical calcium‑channel blockers such as diltiazem or nifedipine—and these are standard alternatives before injections or surgery [2] [4]. These medicines have side effects (for example headaches with nitroglycerin) and require several weeks of application; sources present them as effective conservative escalations [2] [1].
3. Botulinum toxin (Botox) as a non‑surgical next step
If topical therapy fails after weeks, injecting botulinum toxin into the internal sphincter is a commonly cited next step to decrease muscle spasm and allow healing; multiple clinical sources list Botox as an option that can avoid surgery for many patients [1] [2] [4]. Botox is not guaranteed to work and sometimes needs repeating; it’s presented in guidance as an intermediate therapy between ointments and surgery [1] [2].
4. Surgery: fissurectomy versus sphincterotomy — tradeoffs to weigh
For chronic, nonhealing fissures some surgeons recommend fissurectomy (removing scar tissue and skin tags) or lateral internal sphincterotomy (cutting part of the internal sphincter to lower resting pressure). Bespoke Surgical describes fissurectomy as commonly used and warns that lateral internal sphincterotomy “is not advised in clients who engage in anal intercourse” because it could cause future problems with sex or incontinence—an explicit clinical caution about the tradeoff between healing and functional risk [3]. Other authoritative sources list sphincterotomy as highly effective for healing but note it carries incontinence risk, so it’s reserved for refractory cases [2] [4].
5. Sexual activity, dilation and rehabilitation: conflicting practical advice
Patient‑facing outlets and specialty clinics offer practical advice: some clinicians and community resources recommend pausing penetrative sex until healed, using ample lubrication and gradual dilation or pelvic‑floor therapy to prevent recurrence, and getting care in queer‑friendly clinics to avoid stigma (San Francisco AIDS Foundation; HIVPlus; Guy’s & St Thomas’ guidance) [6] [7] [8]. At the same time, some community clinicians suggest that gentle sexual activity or dilation can help relax the sphincter and aid recovery—but clinical manuals frame rest and symptom‑guided return to sex as safer until healing is confirmed [8] [7]. Both perspectives appear in the reporting; choose the approach that fits your symptoms and medical advice [8] [7].
6. Prevention and context: lubrication, technique and access to competent care
Multiple sources identify prevention as critical: adequate lubrication, slow progressive dilation, avoiding force, and treating constipation reduce risk of fissures from anal sex; community clinics emphasize seeking queer‑friendly care because untreated fissures raise risks (including possible increased HIV transmission risk with exposure) and because stigma can delay help‑seeking [6] [9] [7]. Practical prevention advice appears across community and clinical sources [6] [9] [7].
7. What reporting does not settle / limitations
Available sources do not provide head‑to‑head randomized data comparing every treatment specifically for fissures caused by anal sex versus those from hard stools; most clinical guidance treats mechanism (trauma from sex or stool) similarly and follows the same stepwise algorithm [1] [2]. Also, long‑term comparative rates of sexual dysfunction after procedures (especially among people who practice receptive anal intercourse) are discussed by specific clinics with cautionary language but broader population‑level data are not supplied in these sources [3] [2].
Actionable takeaways: start with fiber, stool softeners, sitz baths and topical lidocaine; escalate to topical nifedipine/diltiazem or nitroglycerin if needed; consider Botox before surgery; and if surgery is contemplated, ask your surgeon about fissurectomy versus sphincterotomy risks—especially for people who continue receptive anal sex [1] [2] [3].