IBS and Anal Fissures

Your digestive condition increases your risk of these anal tears

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Rectal bleeding and an itchy anus with irritable bowel syndrome (IBS) could be caused by an anal fissure, a painful tear in the lining of the anus. Those with constipation-predominant IBS are especially at risk. Hard stools and the straining required to pass them can both lead to anal fissures, as well as other related problems like hemorrhoids.

Anything you do to treat your IBS and get your gastrointestinal system functioning more regularly should also help reduce your risk of anal fissures.

This article discusses anal fissures that can occur as a result of IBS, and what you can do to prevent and treat them.

How Does IBS Contribute to Anal Fissures?

People with constipation-predominant IBS often strain to have a bowel movement. This can lead to small tears in the lining of the opening of the anus.

Anal fissures can be quite painful, particularly during a bowel movement. You may see signs of bleeding, either on the stool, on your toilet paper, or in the toilet.

Any sign of blood associated with your bowel movements needs to be brought to the attention of your healthcare provider as it can be the sign of a serious health problem.

Preventing Anal Fissures

The main recommendation for avoiding fissures is to keep your stool soft. Although this can be difficult to do with IBS, there are a couple of things that you can try:

  • Increase your fiber intake. Do this slowly to allow your body time to adjust without exacerbating your symptoms.
  • Stay well hydrated to help keep your stools soft.
  • Try not to strain during your bowel movements. Stay relaxed and let the process happen on its own.
  • Don't delay your bowel movements. Respect any urges from your body to eliminate and head for a bathroom. While you may not want to use the restroom at work or public restrooms while out of the house, don't hold it in until you get home.
  • Try using bowel retraining strategies as a way to try to establish a more regular schedule for bowel movements, thus encouraging more frequent, and therefore softer, stools. Bowel retraining involves eating regularly scheduled meals, drinking plenty of fluids, and setting a regular time each day to try and have a bowel movement.
  • Talk to your healthcare provider about medication to keep your stools soft, such as Metamucil (psyllium) or Miralax (polyethylene glycol 3350).
Anal fissure treatments
Verywell / Brianna Gilmartin

What to Do When You Have an Anal Fissure

  1. Take a sitz bath, particularly after you have a bowel movement. This is an easy home treatment of sitting in warm water for 15 to 20 minutes. Sitz baths encourage the movement of blood in the area of your anus, which helps promote healing. You can find a sitz bath bowl that fits onto a toilet for convenience.
  2. After bowel movements, clean your anus with cotton balls that have been soaked in warm water. You may have better results if you add a little salt to the water.
  3. Talk to your healthcare provider. Your practitioner may recommend one or more of the following:
  • A suppository medication or a cream to reduce swelling and ease the pain
  • A Botox injection
  • A minor surgical procedure is known as a lateral internal sphincterotomy


Anal fissures are a common complaint of people who have IBS, especially constipation-prevalent IBS. Anal fissures can happen when your stools are hard and dry and/or you strain to have a bowel movement.

You can try preventing anal fissures by drinking plenty of fluids, eating a higher-fiber diet, and practicing bowel retraining. It is also a good idea to talk to your healthcare provider about medications and other treatments that can help you manage your IBS.

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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Choung RS, Rey E, Richard locke G, et al. Chronic constipation and co-morbidities: A prospective population-based nested case-control study. United European Gastroenterol J. 2016;4(1):142-51. doi:10.1177/2050640614558476

  2. Beaty JS, Shashidharan M. Anal fissure. Clin Colon Rectal Surg. 2016;29(1):30-7. doi:10.1055/s-0035-1570390

  3. Schlichtemeier S, Engel A. Anal fissure. Aust Prescr. 2016;39(1):14-7. doi:10.18773/austprescr.2016.007

  4. Bleday R. Patient education: hemorrhoids (beyond the basics). In: Lamont JT, Wenliang C, eds. UpToDate. Waltham, Mass: UpToDate; 2022.

By Barbara Bolen, PhD
Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome.