Treating postpartum anal fissures at home: 4 quick tips to relieve pain and burning sensation

Postpartum anal fissures can make each bowel movement a painful experience, accompanied by itching or bleeding, causing many mothers to worry. However, this condition is quite common during pregnancy and postpartum, often related to constipation, hard stools, or straining during defecation. Anal fissures are small tears in the lining of the anal area, and many cases can heal within 4–6 weeks with proper care.

If you are looking for ways to treat anal fissures at home or treat postpartum anal fissures, this article from Tiptory will help you understand the causes, how to care for them to relieve pain and help the fissures heal faster, and recognize when to see a doctor instead of continuing self-treatment.

Part 1: How to treat postpartum anal fissures at home

Tip 1: Warm water sitz baths help relieve pain

Soak the anal area in warm water after bowel movements

• Sit in a basin or tub of warm water so that the anal area is directly immersed. This method helps to gently cleanse without rubbing with toilet paper, and can also help relax the anal sphincter and reduce discomfort caused by postpartum anal fissures.

• A convenient time is after each bowel movement, especially when the anal area is painful or spasming. This is one of the commonly used methods to treat anal fissures at home to help reduce symptoms.

Prepare the sitz bath correctly

• You can use a specialized sitz bath chair or basin placed on the toilet. This device is usually available at medical supply stores, and you can ask medical staff for guidance on choosing one.

• Pour warm water into the sitz bath. Before sitting down, check the temperature with your hand to ensure the water is comfortable and does not cause burns or increase pain.

• There's no need to use overly hot water. The goal is to create a warm, comfortable sensation to relax the anal area.

Soak for about 10–20 minutes

• Sit still in warm water for about 10–20 minutes, avoiding sudden changes in posture or vigorous movements.

• If the device has a drain hole, water can be drained and refilled as needed to maintain a suitable temperature.

• If there is no drainage system, change the water periodically to keep it clean and warm enough.

• After soaking, gently dry the anal area, avoiding rubbing the fissure.

Notes when treating anal fissures at home

• Warm water soaking primarily helps relieve pain, relax muscles, and cleanse the anal area; it should not be considered the only method to treat anal fissures.

• If pain or bleeding persists, symptoms worsen, or the fissure shows no signs of improvement, you should see a doctor to determine the cause and receive appropriate treatment.

Tip 2: Increase fiber for softer stools

Supplement with enough fiber daily

• A high-fiber diet helps soften stools, promotes regular bowel movements, and reduces straining. This is an important factor when treating anal fissures at home, as hard stools and constipation can irritate the fissure or prolong healing.

• Adult women typically need about 21–25 g of fiber per day, depending on age. However, fiber intake should be increased gradually to allow the body to adapt, especially if your diet was previously low in fiber.

Prioritize high-fiber foods

• Fruits: berries, apples, oranges, pears, raisins, and figs. You can eat both the flesh and skin of suitable fruits to increase fiber intake.

• Whole grains: whole-wheat bread, whole-wheat pasta, oats, and bran-rich products.

• Vegetables: broccoli, peas, potatoes, and Brussels sprouts.

• Legumes and nuts: black beans, lima beans, baked beans, and some high-fiber nuts.

Increase fiber but not too suddenly

• When aiming to treat anal fissures, the goal is not just to eat a lot of fiber, but to help soften stools, make them easier to pass, and reduce straining.

• Increase fiber gradually and drink enough water to support the digestive system. Increasing too quickly can cause bloating, abdominal distension, or discomfort.

• If you are experiencing anal pain, you should limit dry, hard, or sharp-edged foods such as popcorn, potato chips, and some hard nuts if they cause indigestion or discomfort.

Prioritize stool softening to aid fissure healing

• When postpartum anal fissures are related to constipation or hard stools, maintaining a high-fiber diet can help reduce pressure during bowel movements.

• If you have adjusted your diet but still experience constipation, severe pain, or prolonged bleeding, you should consult a doctor for evaluation and selection of appropriate stool softeners.

Tip 3: Drink enough water to soften stools

Supplement with enough water daily

• Drinking enough water helps the body maintain hydration and helps soften stools, thereby reducing straining during bowel movements. This is especially helpful when postpartum anal fissures cause pain each time you defecate.

• When stools are soft and easier to pass, the anal area is under less pressure, creating favorable conditions for the fissure to heal.

Prioritize plain water

• Plain water should be the main source of fluids throughout the day. It's not necessary to only drink water during meals; distribute water intake evenly throughout the day according to your body's needs.

• Limit sugary drinks, high-sugar beverages, or other liquid substitutes for plain water if they don't fit your diet.

• Combine adequate water intake with a high-fiber diet to more effectively treat anal fissures at home.

Actively carry water when out

• Prepare a water bottle to sip throughout the day, especially when you feel thirsty.

• Water needs vary from person to person and depend on the weather, activity level, diet, and breastfeeding status. Therefore, do not force yourself to drink a fixed amount without medical advice.

Drink water in combination with other measures

• Drinking enough water is only one part of the process of treating anal fissures. To limit constipation and reduce irritation in the anal area, combine it with eating enough fiber, avoiding forceful straining during bowel movements, and maintaining gentle anal hygiene.

• If pain or bleeding does not decrease, symptoms recur, or the fissure does not heal for an extended period, you should see a doctor for an evaluation of the cause and appropriate treatment.

Tip 4: Light exercise helps limit constipation

Maintain postpartum activity

• Regular exercise can help stimulate bowel movements, promote regular defecation, and limit constipation. This is an important factor when treating anal fissures at home, as constipation and straining can make fissures more painful or take longer to heal.

• If your health permits, aim for about 30 minutes of physical activity most days of the week. It's not necessary to exercise continuously; you can break it into several short exercise sessions throughout the day.

Start with appropriate exercises

• After childbirth, prioritize light activities such as slow walking, body movements, or recovery exercises guided by healthcare professionals.

• The intensity and timing of starting exercise depend on the type of delivery, recovery process, and individual health status.

• Do not try to exercise if you are still in severe pain, dizzy, experiencing abnormal bleeding, or feeling unwell.

Ask your doctor before increasing exercise intensity

• If you are in the postpartum recovery phase, discuss with your doctor or healthcare professional about the type and appropriate level of exercise.

• Especially if postpartum anal fissures are accompanied by severe pain, bleeding, or prolonged constipation, evaluating the cause will help choose a more suitable way to treat anal fissures.

Combine exercise with other measures

• Exercise does not directly heal fissures, but it can help control constipation and create favorable conditions for the healing process.

• To treat anal fissures at home, combine appropriate exercise with adequate water intake, sufficient fiber, and avoiding straining during bowel movements.

Part 2: When should postpartum mothers with anal fissures see a doctor?

Tip 1: Topical medication helps relieve anal pain

Prioritize topical anesthetics for severe pain

• Topical anesthetics like lidocaine can help relieve pain for a short period, especially when pain occurs before or during bowel movements. Expert guidelines view anesthetics as a supportive measure, not the primary method for healing fissures.

• Some anesthetics can be purchased over-the-counter, while others require a doctor's prescription. Therefore, when postpartum anal fissures cause severe pain, you should ask a doctor or pharmacist about the appropriate medication instead of self-selecting.

• If breastfeeding, some topical anal medications like lidocaine may be used in appropriate cases, but it is still best to use the lowest effective dose for the shortest duration.

Apply medication at the right time and in the right way

• If prescribed, apply a small amount of medication to the anal area according to your doctor's instructions or the product information, usually before bowel movements when pain is the prominent issue.

• Wash your hands before and after applying medication. Do not rub vigorously on the fissured area as this can increase irritation.

• Do not increase the amount of medication or frequency of application on your own in hopes of faster anal fissure treatment. Excessive use of anesthetics can increase the risk of irritation or unwanted side effects.

Do not use steroid creams for extended periods without medical supervision

• Some anal preparations may combine anesthetics with corticosteroids like hydrocortisone. Corticosteroids have anti-inflammatory effects but should generally only be used for short periods and should be avoided when there is an untreated infection.

• Do not use steroid creams for extended periods of several weeks on your own. The specific duration of use depends on the type of medication and the condition; some guidelines limit corticosteroid-containing preparations to a few days to a maximum of about 1 week.

• Therefore, if the goal is to treat anal fissures at home, steroid creams should not be considered the primary treatment option or used for extended periods to replace constipation management.

Treating the underlying cause is still a crucial step

• Anesthetics primarily help control pain, while keeping stools soft, avoiding constipation, and limiting straining are the foundations of anal fissure care.

• If the fissure does not improve with initial care measures, a doctor may consider specialized topical medications such as diltiazem or glyceryl trinitrate to aid the healing process. These medications should be used under medical guidance.

Special considerations postpartum

• If anal pain is severe, bleeding is profuse, symptoms persist, or worsen, you should not continue self-treatment. Postpartum anal fissures sometimes need to be checked by a doctor to rule out other causes and select safe medications during recovery or breastfeeding.

• Professional guidelines note that acute postpartum anal fissures typically prioritize conservative treatment rather than rushing to surgical procedures affecting the anal sphincter.

Tip 2: Stool softeners to reduce pain during bowel movements

Use stool softeners when needed

• Stool softeners can help stool pass more easily through the anus, thereby reducing pain and limiting straining. This is one of the supportive measures used in conservative treatment of anal fissures.

• Do not self-select medication based solely on the product name. A doctor can assess the constipation and choose the appropriate medication and dosage for each case.

Use medication according to instructions

• Read the instructions carefully and only use the recommended dose or the dose prescribed by your doctor.

• Do not increase the dose yourself if you don't see immediate results. Some laxatives can cause bloating, abdominal pain, or diarrhea if used improperly.

• If significant side effects occur or constipation does not improve, contact your doctor to adjust the treatment method.

Special considerations if breastfeeding

• Postpartum, medication selection needs to consider both the mother's and the baby's condition. Many laxatives have low systemic absorption and can be used while breastfeeding, but the specific choice should still be based on a healthcare professional's assessment.

• According to NHS Specialist Pharmacy Service guidelines, some options such as docusate, lactulose, macrogol 3350, and psyllium (ispaghula husk) can be used during breastfeeding in appropriate cases.

• If the baby is premature, unwell, or the mother is taking multiple medications, you should ask your doctor or pharmacist before using stool softeners.

Combine stool softening with lifestyle adjustments

• Medication is only one part of the process of treating anal fissures at home. The important goal is to maintain soft, formed, and easy-to-pass stools to reduce repeated damage to the fissure.

• Combine medication when needed with a high-fiber diet, adequate water intake, and appropriate postpartum exercise. These measures help control constipation and support the healing process of the fissure.

Do not strain during bowel movements

• When you feel the urge to defecate, go immediately instead of holding it in for a long time. Straining forcefully can increase pressure on the anal area and make postpartum anal fissures more painful or take longer to heal.

• If pain and bleeding persist despite stool softening and home care, you should see a doctor to determine the cause and choose the appropriate method for treating anal fissures.

Tip 3: Ask your doctor about nitroglycerin

Discuss topical nitroglycerin with your doctor

• Nitroglycerin (glyceryl trinitrate) is a topical medication that works by relaxing the anal sphincter, thereby reducing pressure and spasms in this area, and improving blood flow to the fissure. As a result, the medication can support the healing process of anal fissures.

• Topical nitroglycerin is often considered more when anal fissures are persistent or do not fully respond to initial care measures. Guidelines from the American Society of Colon and Rectal Surgeons (ASCRS) note that topical nitrates are a treatment option, but side effects may limit their use.

• Since this medication needs to be selected and used appropriately for each individual, you should not buy it yourself and self-adjust the dose to treat anal fissures.

Use medication exactly as directed

• If your doctor prescribes the medication, use the correct amount, location, and frequency as directed. Do not increase the dose yourself, as a higher dose does not necessarily help the fissure heal faster but may increase side effects.

• When applying medication to the anal area, wash your hands before and after use. Avoid direct contact with the eyes or areas of skin that do not require treatment.

• Do not insert applicators or fingers deep into the anus. If you have not been instructed on how to apply, ask your doctor or pharmacist to do so safely.

Beware of headache and dizziness risks

• Headache is the most common side effect of topical nitroglycerin. Professional guidelines suggest that this side effect may be dose-dependent and sometimes leads to patients discontinuing the medication.

• Some people may experience dizziness or lightheadedness due to the medication dilating blood vessels and lowering blood pressure. If clear symptoms appear, especially lightheadedness or near-fainting, contact your doctor for guidance.

• Do not increase the dose yourself if the effect is not clear. Your doctor may consider switching to another option if side effects make treatment difficult to continue.

Can be used during breastfeeding in appropriate cases

• According to the NHS Specialist Pharmacy Service, topical glyceryl trinitrate can be used to treat anal fissures during breastfeeding. The amount of medication expected to be absorbed into breast milk from topical application is low.

• This recommendation applies to full-term, healthy infants. If the infant is premature, unwell, or the mother is taking multiple medications, discuss with your doctor or pharmacist before use.

• After applying the medication, wash your hands thoroughly before caring for or breastfeeding your baby to avoid direct contact with the medication.

Combine with home care

• Nitroglycerin medication does not replace foundational measures in home treatment of anal fissures. Maintaining soft stools by eating enough fiber, drinking enough water, and using stool softeners when indicated are still very important.

• For postpartum anal fissures, the goal is to reduce constipation, minimize straining, and reduce sphincter spasms to allow the fissure to heal.

• If treatment does not improve, or pain or bleeding persists, seek re-examination. Your doctor may consider other topical medications such as diltiazem; ASCRS guidelines suggest that topical calcium channel blockers are similarly effective to nitrates but generally have a more favorable side effect profile.

Part 3: Postpartum anal fissure surgery: When should it be performed?

Note 1: When does an anal fissure require surgery?

Surgery is often reserved for persistent anal fissures

• The majority of acute anal fissures can improve with non-surgical measures such as stool softeners, fiber supplements, warm sitz baths, and appropriate topical medications. According to the guidelines of the American Society of Colon and Rectal Surgeons (ASCRS), conservative treatment is usually the first choice.

• If the fissure persists, recurs, or does not respond to medical treatment, your doctor may consider surgery. Therefore, it should not be assumed that every postpartum anal fissure requires surgery.

Surgery helps relax the anal sphincter

• The commonly used method is lateral internal sphincterotomy (LIS). The doctor carefully cuts a portion of the internal anal sphincter to reduce spasms and pressure on the fissure area, facilitating wound healing.

• This is typically an outpatient procedure and is highly effective for chronic anal fissures in appropriately selected individuals. ASCRS reports a fissure healing rate of approximately 88–100% in evaluated studies.

Not everyone is suitable for surgery

• Before deciding on surgery, the doctor needs to assess the risk of affecting the ability to control gas or stool.

• In particular, women who have experienced sphincter damage during childbirth, have fecal incontinence, have undergone previous anal surgery, or have certain bowel conditions need careful consideration before undergoing sphincterotomy.

• For high-risk individuals, the doctor may consider sphincter-sparing methods, such as anal flap surgery, instead of sphincterotomy.

Don't wait too long if the fissure doesn't improve

• If you have applied home remedies for anal fissures and followed treatment guidelines, but the condition persists, or pain or bleeding recurs, you should see a proctologist.

• The doctor will determine whether the fissure is still in the acute or chronic stage, and evaluate factors such as constipation, sphincter spasms, and a history of postpartum trauma before choosing a treatment for anal fissures.

• For postpartum women, thorough evaluation is particularly important because a history of obstetric sphincter damage can alter treatment options.

Surgery is highly effective but still carries risks

• Lateral internal sphincterotomy has a high fissure healing rate, but there is still a risk of affecting the ability to control gas or stool. The level of risk varies depending on the technique, follow-up period, and individual characteristics.

• Therefore, the goal of anal fissure treatment is not to choose the most aggressive intervention, but to select the method that achieves effective fissure healing with the lowest risk for each individual.

Note 2: Thorough preparation before surgery

Follow your doctor's instructions

• Before anal fissure surgery, your doctor will provide specific instructions on what to prepare based on your health status and the planned surgical method.

• Ask questions immediately if you don't understand any requirements, especially regarding diet, current medications, and bowel preparation. Do not unilaterally change pre-surgical instructions.

Fast as directed

• Depending on the type of anesthesia or local anesthetic and the medical facility's protocol, you may be asked not to eat or drink for a certain period before surgery.

• Do not assume a "fast from midnight" rule if your doctor does not require it. The fasting period must strictly adhere to the instructions of the surgical and anesthesia team.

Check current medications

• Inform your doctor of all medications you are taking, including prescription drugs, over-the-counter medications, vitamins, supplements, and herbal products.

• Some medications may need to be temporarily stopped or adjusted before surgery, but do not stop medications on your own, especially those for chronic conditions or those affecting blood clotting.

• If you are breastfeeding postpartum, inform your doctor and anesthesiologist for appropriate guidance on medications before and after surgery.

Bowel preparation if required

• Some anal surgeries may require bowel cleansing before the procedure. Your doctor may prescribe laxatives or enemas depending on the protocol.

• Do not buy laxatives or perform enemas on your own without guidance, as preparation methods depend on the surgical approach and individual patient condition.

Actively prepare for surgery day

• Ask in advance about the time to arrive at the hospital, the method of anesthesia, estimated recovery time, and signs to monitor after surgery.

• If your doctor requires fasting or abstaining from liquids, plan ahead to avoid accidentally eating or drinking at the wrong time.

• For postpartum anal fissures, providing full information about the birth process, constipation status, current medications, and breastfeeding will help the doctor choose a safer anal fissure treatment option.

Note 3: Post-operative anal fissure care

Monitor and rest on the first day

• Anal fissure surgery can often be performed as an outpatient procedure, and patients can go home if no complications occur. However, discharge time depends on the surgical method, health status, and doctor's assessment.

• After returning home, follow specific instructions on wound care, pain medication, hygiene, and follow-up appointments.

Gentle and gradual movement

• Do not lie or sit still for too long. When your doctor allows, start walking gently and gradually increase your activity level.

• Light walking after surgery can help maintain circulation and reduce the risk of blood clot formation in at-risk individuals.

• Avoid heavy lifting, high-intensity exercise, or activities that cause pain in the anal area until your doctor gives permission.

Only drive when it is safe enough

• The time to return to work may vary depending on the type of surgery, the nature of the job, and the recovery rate; some people may need to rest for several days to several weeks.

• Do not drive while taking pain medication that causes drowsiness, dizziness, or reduces reaction time.

• Only return to driving when you can sit comfortably, operate the vehicle, and brake urgently without pain or limited movement.

Keep the wound clean and dry

• After surgery, there may still be a wound in the anal area, and a small amount of fluid or blood may appear for the first few days. You can use clean gauze as directed to absorb fluid and protect the surgical area.

• Clean gently after bowel movements, avoiding rubbing or using products that may cause irritation.

• If your doctor allows, soaking the anus in warm water can help clean the surgical area and reduce discomfort. Do not add soap, antiseptics, or chemicals to the soaking water on your own.

Warm water soaks as directed

• Your doctor may instruct you to take warm water soaks several times a day, depending on the wound condition and surgical method.

• After soaking, gently pat dry with a clean towel or gauze instead of rubbing.

• The goal of home care is to keep the anal area clean, minimize irritation, and promote wound healing.

Pay attention to unusual signs

• Some pain, discomfort, or bleeding may occur in the early stages, but heavy bleeding, rapidly increasing pain, fever, swelling, redness, or unusual discharge need to be checked by a doctor.

• If after postpartum anal fissure surgery unusual symptoms appear or the wound does not heal as expected, do not try to treat it yourself at home for an extended period.

• The recovery process will be smoother by continuing to maintain soft stools, drink enough water, eat enough fiber, and avoid straining during bowel movements.

When to consult a doctor about anal fissures?

Discuss Botox injections if treatment is ineffective

• Botox injections may be considered by a doctor in some cases of chronic anal fissures that do not respond well to other treatment methods. Botox helps reduce anal sphincter spasms, thereby facilitating fissure healing.

• However, the effectiveness of Botox is not always consistent, and this option is not suitable for everyone. The doctor will consider it based on the duration of the condition, the severity of symptoms, and previously used methods.

• Do not consider Botox as the first anal fissure treatment option without evaluation by a specialist.

Ask your doctor before taking medication if you are breastfeeding

• If you are breastfeeding, do not self-medicate with oral medications, topical creams, or suppositories to treat anal fissures at home.

• Inform your doctor or pharmacist that you are breastfeeding to choose medications with appropriate safety data.

• Even over-the-counter medications or herbal products should be checked before use, as some active ingredients can be absorbed into the body and affect the baby.

Monitor the amount of blood when having a bowel movement

• A few streaks of bright red blood on toilet paper or on the surface of the stool may appear with anal fissures, especially after a bowel movement. However, do not assume that all cases of anal bleeding are due to fissures.

• If the amount of blood is more than a few small streaks, flows in a stream, recurs frequently, or is accompanied by dizziness, fatigue, abdominal pain, fever, or unusually colored stools, contact a doctor for evaluation.

• Prolonged or heavy anal bleeding can be related to causes other than postpartum anal fissures, so do not continue self-treatment and ignore warning signs.

Do not delay if symptoms are unusual

• If pain increases, bleeding is heavy, fever appears, or the anal area becomes swollen, red, or has unusual discharge, seek early medical attention.

• For postpartum anal fissures, correctly identifying the cause helps avoid unnecessary medication and choose a safer treatment method, especially during breastfeeding.

References

1. American Society of Colon and Rectal Surgeons. (2023). The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures. Diseases of the Colon & Rectum, 66(2), 191–201.
2. Nelson, R. L. (2008). Non surgical therapy for anal fissure. Cochrane Database of Systematic Reviews. Cochrane Library.
3. National Institute for Health and Care Excellence. (2024). Chronic anal fissure: botulinum toxin type A injection. NICE Evidence Summary.
4. Specialist Pharmacy Service. (2024). Treating rectal and anal disorders during breastfeeding. NHS Specialist Pharmacy Service.
5. National Health Service. (2023). Glyceryl trinitrate (GTN): a medicine for angina and anal fissures. NHS.
6. National Health Service. (2023). Pregnancy, breastfeeding and fertility while taking glyceryl trinitrate (GTN). NHS.
7. Guy’s and St Thomas’ NHS Foundation Trust. (2023). Anal fissure treatment. Guy’s and St Thomas’ NHS Foundation Trust.
8. UK Medicines Information. (2015). Is topical glyceryl trinitrate for anal fissure compatible with breastfeeding? Medicines Q&As, NHS.

Content edited by: Ashley Wright Nguyen.

Information consulted and verified by expert: Evelyn Clark.