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What are the typical symptoms of an anal fissure?
Executive summary
Anal fissures typically cause sharp, severe pain during and often after bowel movements and bright red bleeding on the stool or toilet paper; most sources say pain can last minutes to hours and about 90% heal without surgery (examples: severe pain with bowel movements; bleeding; healing rate) [1] [2] [3]. Available reporting consistently lists pain, bleeding, and localized discomfort as core symptoms, and also notes itch, fear of defecation, and spasm-related prolonged pain as common accompanying features [4] [5] [6].
1. What patients usually feel: “Passing glass” — intense pain with defecation
Nearly every clinical source describes the hallmark symptom as sharp, burning, or tearing pain during bowel movements; patients often use stark metaphors such as “shards of glass” to convey the sensation. This pain may persist for minutes to a few hours afterwards because the internal sphincter can go into spasm, prolonging discomfort beyond the actual stool passage [4] [7] [6].
2. Bleeding and visible signs: bright red blood on stool or toilet paper
Anal fissures frequently produce bright red bleeding that’s usually seen on the surface of the stool or on toilet paper after wiping. Several major patient‑education sites list this as a typical sign and recommend clinicians inspect the anus if bleeding is reported [3] [2] [8].
3. Episodic pattern: symptom-free between bowel movements, fear of passing stool
Sources note patients are often symptom-free between bowel movements; because the pain is so intense during defecation, people may develop anxiety or fear about passing stool, which can worsen constipation and perpetuate the fissure [4] [9].
4. Other local signs: itching, soreness, and skin tags during healing
Itching and local irritation can accompany fissures and may even signal healing as wounds can itch when epithelialization occurs. Chronic fissures sometimes leave a sentinel skin tag near the tear — a scar-like change clinicians may observe [5] [10].
5. Duration and acute vs chronic presentation
Most fissures are acute and heal with self‑care within weeks; a minority become chronic if the tear is repeatedly re‑injured or the sphincter remains in spasm. Johns Hopkins and other clinics estimate the majority heal without surgery, with chronic or refractory cases requiring specialist evaluation [2] [4].
6. Causes that explain the symptoms: constipation, hard stools, childbirth, IBD
Clinical pages link the common causes (hard or large stools, straining, childbirth) to the mechanism of tearing and pain. Inflammatory conditions (such as Crohn disease) or prior anorectal procedures can also produce fissures and similar symptom profiles [3] [2] [7].
7. When symptoms mimic other conditions: hemorrhoids and infections
Anal fissure symptoms—especially pain and bright red bleeding—overlap with hemorrhoids and some infections; professional sources warn misidentification is common and recommend inspection and, when needed, tests to exclude other causes of rectal bleeding [1] [2].
8. What the guidance says about seeking care
NHS and other providers advise medical review if symptoms worsen or don’t improve after about a week of home measures, or if bleeding is heavy, because persistent symptoms may require further treatment or specialist referral [8] [10].
Limitations and disagreements in coverage
The provided sources agree on the core symptoms (severe pain with bowel movements, bright red bleeding, local discomfort/itching) and on common causes and healing patterns; they differ mainly in emphasis and detail (for example, some sites quantify healing timelines or recurrence rates while others focus on symptom descriptions) [2] [4] [8]. Available sources do not mention rarer presentations such as numbness or systemic symptoms as typical for simple fissures; if you’re experiencing unusual signs, current reporting does not cover those here (not found in current reporting).
Bottom line for readers
If you have sudden, sharp anal pain with bright red bleeding when you pass stool, the symptom pattern across multiple clinical sources is most consistent with an anal fissure; try conservative measures first but seek medical review if pain or bleeding persist beyond a few days or worsen [1] [8] [2].