Most hemorrhoids and anal fissures heal within a few weeks using the same core strategies: softer stools, less straining, and targeted pain relief. These two conditions often show up together because they share the same root causes, but they differ in important ways that affect which treatments work best. Here’s how to address both effectively.
Hemorrhoids vs. Fissures: Know What You’re Treating
Hemorrhoids are swollen veins around the anus that form lumps. They cause itching, mild discomfort, and sometimes bleeding, but most don’t actually hurt much. You might notice them as soft bumps near or just inside the anal opening.
Anal fissures are small tears in the skin lining the anus. They’re more painful than hemorrhoids, often causing sharp or burning pain during and after bowel movements, along with bright red blood on toilet paper. The pain comes from the exposed tear itself and the muscle spasm it triggers underneath.
Both conditions can bleed, itch, and make sitting uncomfortable. But if your main symptom is a sharp, stinging pain when you pass stool, a fissure is the more likely culprit. If you feel a painless lump or persistent itching, hemorrhoids are more probable. It’s common to have both at once, since the straining that causes one tends to cause the other.
Fix Straining First
Straining during bowel movements is the single biggest factor in both hemorrhoids and fissures. It increases pressure on anal veins and stretches the delicate skin lining the anal canal. Until you reduce straining, topical treatments are just managing symptoms while the underlying cause continues.
The most effective change is increasing fiber intake. The recommended target is about 14 grams of fiber per 1,000 calories you eat, which works out to roughly 28 grams per day on a standard 2,000-calorie diet. Most people fall well short of this. Good sources include beans, lentils, oats, berries, broccoli, and whole grains. If you can’t get enough through food, a fiber supplement containing psyllium works well. Psyllium is a bulk-forming fiber that draws water into stool, making it softer and easier to pass while also stimulating the bowel to move things along.
Stool softeners (like docusate) are another option, especially if you’re dealing with an active fissure and need immediate relief from painful bowel movements. They work by pulling water into the stool rather than adding bulk. For hemorrhoids and fissures specifically, they’re a helpful short-term bridge while you increase your fiber intake.
Drink more water as you increase fiber. Fiber without adequate fluid can make constipation worse.
Change How You Sit on the Toilet
Your posture on the toilet has a surprisingly large impact on how hard you strain. When you sit upright on a standard toilet, a muscle called the puborectalis creates a kink in your rectum at roughly a 100-degree angle. This partial kink means you need more effort to push stool through.
Raising your knees above your hips, either with a small footstool or a squatting platform, straightens that angle to about 126 degrees. In studies comparing postures, people using a squatting position reported significantly less straining and faster bowel movements, averaging under a minute compared to over two minutes while sitting normally. They also felt more complete emptying afterward. A $20 toilet stool can meaningfully reduce the pressure on hemorrhoids and fissures with every bowel movement.
Sitz Baths for Pain and Healing
A sitz bath is one of the most effective home treatments for both conditions. You sit in a few inches of warm water, soaking just the anal area. The warmth increases blood flow to the tissue, relaxes the anal muscles (which helps fissures especially), and provides immediate pain relief.
Use water around 104°F (40°C), comfortably warm but not hot enough to burn sensitive tissue. Soak for 15 to 20 minutes per session. For active symptoms, three to four baths a day is the standard recommendation. You can use a sitz bath basin that fits over your toilet rim or simply sit in a shallow bathtub. Pat the area dry afterward rather than rubbing.
Over-the-Counter Treatments for Hemorrhoids
Several OTC products can help manage hemorrhoid symptoms while your body heals. Witch hazel pads (like Tucks) have a natural astringent effect that soothes irritated tissue. Creams containing lidocaine numb the area for short-term pain relief, while hydrocortisone reduces inflammation and itching. Products with phenylephrine (like Preparation H) work by constricting blood vessels to shrink swollen tissue.
These products treat symptoms, not the underlying cause. They work best as part of a broader approach that includes the dietary and behavioral changes above. Hydrocortisone creams in particular shouldn’t be used for extended periods, as they can thin the skin over time.
Treating Anal Fissures Specifically
Acute fissures, meaning those that developed recently, typically heal on their own within four to six weeks with conservative care: fiber, sitz baths, stool softeners, and avoiding straining. Most people don’t need anything beyond this.
If a fissure doesn’t heal within six weeks, it’s considered chronic. Chronic fissures involve a deeper tear and usually need prescription treatment. Two topical ointments are commonly prescribed: a nitroglycerin-based cream (0.2% concentration) and diltiazem cream (2% concentration). Both work by relaxing the tight anal muscle that prevents blood flow to the tear, allowing it to finally heal. They’re equally effective at closing the fissure, but diltiazem has a 30% lower recurrence rate and is far less likely to cause headaches, a common and sometimes intense side effect of nitroglycerin ointment.
You apply these ointments directly to the anal area, typically twice daily for several weeks. The muscle relaxation they provide breaks the cycle of spasm, poor blood flow, and re-tearing that keeps chronic fissures from closing.
When Home Treatment Isn’t Enough
For hemorrhoids that don’t respond to fiber, OTC creams, and lifestyle changes, rubber band ligation is the most common next step. A small rubber band is placed around the base of the hemorrhoid, cutting off its blood supply. The tissue shrinks and falls off within a week or so. It’s done in a clinic visit, not an operating room, and most people return to normal activities quickly. This is typically recommended when hemorrhoids keep causing symptoms despite consistent at-home treatment.
For chronic fissures that don’t respond to prescription ointments, a minor surgical procedure called a lateral internal sphincterotomy is considered the definitive treatment. It involves a small cut in the tight anal muscle to permanently reduce the tension that prevents healing. It has a high success rate, but because it slightly alters muscle function, it’s reserved for fissures that have genuinely failed other treatments.
Daily Habits That Prevent Recurrence
Both hemorrhoids and fissures have high recurrence rates, so prevention matters as much as treatment. Keep fiber intake consistently at or near 28 grams per day, even after symptoms resolve. Drink enough water that your urine stays light yellow. Don’t sit on the toilet longer than necessary: scrolling your phone for 15 minutes while sitting creates sustained pressure on anal veins. When you feel the urge to go, go. Delaying bowel movements leads to harder stool and more straining later.
Regular physical activity helps keep your digestive system moving. Even daily walking reduces constipation risk. If you sit for long periods at work, standing or walking breaks reduce the sustained pressure on the pelvic floor that contributes to hemorrhoid flare-ups.