There is a topic that tens of thousands of Australians are Googling in private, usually in a quiet moment of panic after a painful trip to the toilet. It goes something like: "why does it hurt after I poo?" or "small tear near anus?" or, more desperately, "why is this not getting better?"

They are almost certainly describing an anal fissure. And they are far from alone.

Anal fissures affect an estimated 10 to 15 per cent of the general population - and that number is probably higher, because most people never tell a soul. Not their GP. Not their partner. Not even their closest friend. The silence around this part of the body means a condition that is genuinely common gets treated as though it is shameful or rare, and people end up suffering quietly for months or sometimes years.

This piece exists to change that. We sat down with Dr. Hamish Urquhart, a colorectal surgeon at St. Vincent's Hospital in Sydney, to get the full picture - what fissures actually are, what causes them, why they are so stubborn to heal, and what actually helps.

No shame. No jargon. Just clear, honest information about a part of your body that deserves better care.

 

So, What Actually Is an Anal Fissure?

An anal fissure is a small tear in the lining of the anal canal - the last few centimetres of your digestive tract before the exit. Think of it like a paper cut, but in a location that gets no rest and has very little tolerance for irritation.

The tear itself can start tiny - sometimes less than a millimetre wide, barely the width of a hair. But because of where it is, even a minor fissure can cause disproportionate pain, particularly during and after a bowel movement.

What makes fissures especially frustrating is how long they stick around. Unlike a cut on your finger, which heals in a few days, anal fissures can persist for weeks, months, or even years. There is a physiological reason for this, which we will get to shortly.

 

What Causes One?

This is where a lot of people get it wrong. Anal fissures are not a condition associated with any particular lifestyle or type of sex. They affect people across every age group, demographic, and sexual preference - from babies to 95-year-olds, as Dr. Urquhart has seen in his practice.

The most common cause, by a wide margin, is constipation and the passage of hard stools. But fissures can also be triggered by:

• Diarrhoea or repeated loose stools
• Childbirth
• Aggressive wiping
• A particularly dry day when the skin has less elasticity than usual
• Anal play that is rushed or not properly warmed up

That last point is worth addressing directly: yes, butt play can contribute to fissures if the area is not given time to relax and adjust. But it is not a primary cause, and it does not make fissures a "gay condition" or a consequence of any particular sexual behaviour. The plumbing is the same for everyone.

 

How Do You Know If You Have One?

The symptoms of an anal fissure are fairly specific, which is useful because they can be confused with haemorrhoids. The key distinctions, according to Dr. Urquhart:

If your bleeding is painless, haemorrhoids are more likely the cause. If you have both pain and bleeding, it is almost certainly a fissure - though the two can coexist. Either way, it is worth having it looked at rather than guessing.

Why Do They Take So Long to Heal?

This is the piece most people are missing, and it explains why a fissure that started as something small can drag on for so long.

When the tear occurs, the muscle underneath - the internal anal sphincter - responds by going into spasm. That spasm, in turn, restricts blood supply to the anal canal. And without adequate blood supply, the tissue cannot deliver the nutrients it needs to heal.

So you end up in a cycle: the tear causes spasm, the spasm prevents healing, the lack of healing keeps the tear open, which causes more spasm. An otherwise healthy person can find themselves essentially unable to heal what amounts to a tiny cut, not because anything is wrong with them, but because of this self-perpetuating loop.

Left untreated, a chronic fissure can develop further complications. A small pocket of inflammation can become a sentinel skin tag. Over time, a tunnel can form beneath the ulcer, developing into a fistula - an abnormal connection between the inside and outside of the anal canal. From there, perianal abscesses can form, which require more significant medical intervention. These are not inevitable, but they are a real risk for people who wait years to seek help.

What Actually Helps?

The good news is that around half of fissures resolve without medical treatment, provided the right conditions are in place. Conservative management should always be the starting point.

Diet and hydration. Increasing fibre intake is one of the most evidence-backed steps you can take. Research shows that adding a daily tablespoon of psyllium husk can reduce haemorrhoid recurrence rates by 50 per cent - and the same logic applies to fissures, since both conditions are aggravated by straining and hard stools. Drink more water. Add vegetables, legumes, or a fibre supplement.

Toilet habits. Limit time on the loo to one or two minutes. Sitting on the bowl - even without straining - pumps blood into the anal region and causes engorgement over time. Wipe gently. Consider using wet wipes, or simply rinse with warm water in the shower after going.

Barrier protection. Keeping the skin protected is critical. Think of it the way Dr. Urquhart does: if you had a cracked lip, you would reach for a good lip balm to protect and nourish it while it healed. Your anal canal deserves the same care. A gentle, non-irritating barrier ointment - like our Sore Butt Soothing Balm - can help protect the skin and support the conditions for healing.

Warm soaks. Sitting in a warm bath for ten to fifteen minutes a day can help relax the sphincter muscles and improve blood flow to the area - directly addressing the spasm cycle described above.

Prescription options. If conservative care is not working, a GP or colorectal surgeon can prescribe topical treatments that relax the sphincter to allow healing. Rectogesic (glyceryl trinitrate) is commonly used but frequently causes headaches. Compounded diltiazem cream is another option with a better side effect profile. Both require a script.

When to escalate. If your symptoms are severe, not improving after two to three weeks of self-care, or if you notice swelling, discharge, or fever, see a doctor. Do not wait years. As Dr. Urquhart says, early intervention means a much faster and less complicated recovery.

A Word on Shame

One of the most consistent things Dr. Urquhart observes in his practice is how long people wait before seeking help. Not because they do not know something is wrong, but because they feel embarrassed about where the problem is.

Patients arrive having lived with a fissure for a decade. They have been too ashamed to bring it up with their GP, or they did bring it up and did not get the response they needed. Either way, they have been quietly enduring something that is painful, isolating, and entirely treatable.

Colorectal surgeons are not there to judge. Dr. Urquhart and his colleagues perform around 30 rectal examinations per day. They have seen everything. What they care about is helping you get better - and that starts with you walking in the door.

Your butt is a part of your body. It deserves care, attention, and the occasional tube of something good.

About the Author

Mark Lyons is the founder of Happie Holl, a Melbourne-based butt care brand born from personal experience with a chronic anal fissure and a frustrating lack of practical advice from mainstream medicine. Now known as the Butt Guru, he is on a mission to make butt health something everyone can talk about openly.

Medical Note

This article is informed by an interview with Dr. Hamish Urquhart, Colorectal Surgeon at St. Vincent's Hospital Sydney and the Sydney Colorectal Clinic, conducted for The Hole Conversation podcast by Happie Holl. It is intended for general information only and does not constitute medical advice. If you have concerns about your health, please consult a qualified healthcare professional.