How long does fissure ointment take to work?

October 11, 2025 •

4 min read

According to UCSF Health, most acute anal fissures heal on their own within 4 to 6 weeks with proper self-care. However, when medication is needed, understanding how long does fissure ointment take to work is crucial for managing expectations and ensuring a full recovery.

Quick Summary

Fissure ointments can offer quick pain relief, but complete healing typically takes 6 to 8 weeks of consistent use. The exact timeline depends on the ointment type and fissure severity. Prescription options, like nitroglycerin and calcium channel blockers, work by relaxing the anal sphincter to promote blood flow and speed healing.

Key Points

Timeline Varies: While some symptom relief may be felt within days or weeks, complete healing with fissure ointment typically takes 6 to 8 weeks of consistent use.
Acute vs. Chronic: Ointments are generally prescribed for chronic fissures (lasting over 6 weeks), while acute ones may heal with home remedies alone.
Symptom Relief vs. Healing: Pain relief often occurs much faster than full healing. Stopping treatment early can lead to a relapse.
Different Ointments, Different Speeds: Prescription ointments like nitroglycerin (quick pain relief, common headache side effect) and calcium channel blockers (slower pain relief, fewer systemic side effects) have different effectiveness profiles.
Combination Therapy is Best: For best results, use fissure ointment in conjunction with lifestyle adjustments like increasing fiber intake, staying hydrated, and taking sitz baths.

Understanding the Timeline for Fissure Ointment

When dealing with the pain and discomfort of an anal fissure, one of the most pressing questions is about the speed of recovery. While symptom relief may occur relatively quickly, the full healing process for a fissure requires patience and consistent treatment.

Acute vs. Chronic Fissures

Before addressing the ointment's effect, it's important to distinguish between acute and chronic fissures. This distinction heavily influences the expected healing time.

Acute Fissures: Lasting less than 6 weeks, these often resolve on their own with conservative, at-home treatments like increased fiber intake, stool softeners, and warm sitz baths.
Chronic Fissures: These persist for more than 6 weeks and often require prescription medication, such as fissure ointments, because they are resistant to basic self-care. The extended duration of a chronic fissure often means a longer healing process, even with medication.

How Ointments Promote Healing

Prescription ointments, such as topical nitroglycerin and calcium channel blockers (like diltiazem and nifedipine), work by relaxing the internal anal sphincter muscle. This action achieves two key goals:

Reduced Spasm and Pain: The relaxed muscle decreases the pressure and painful spasms that often prevent the fissure from healing.
Increased Blood Flow: Relaxation of the sphincter widens the blood vessels, allowing increased blood flow to the injured area. This improved circulation delivers more oxygen and nutrients, which are essential for tissue repair.

Symptom Relief vs. Complete Healing

It is common for patients to experience pain relief much faster than the time it takes for the fissure to fully heal. This early improvement can be misleading, and stopping treatment prematurely can lead to a relapse.

Pain Relief: Depending on the type of ointment, pain can begin to subside within days to a couple of weeks. For example, studies on nifedipine suggest earlier pain relief compared to diltiazem, with improvement seen within 4 to 10 days for nifedipine versus 7 to 21 days for diltiazem. For nitroglycerin, initial relief can be felt within hours, though this is temporary.
Full Healing: A complete healing of the fissure wound generally requires consistent use of the prescribed ointment for 6 to 8 weeks, even if the pain has disappeared. This prolonged treatment is necessary to ensure the tear fully closes and is not susceptible to re-injury.

Comparison of Prescription Fissure Ointments

For chronic fissures, doctors often prescribe one of the following topical treatments. While both aim to relax the anal sphincter, their mechanisms and side effect profiles differ.


Feature	Nitroglycerin Ointment (e.g., Rectiv)	Calcium Channel Blocker Ointments (e.g., Diltiazem or Nifedipine)
Mechanism of Action	A nitric oxide donor that causes vasodilation and relaxes the sphincter.	Directly blocks calcium, causing the sphincter muscles to relax.
Symptom Improvement	Pain relief often occurs quickly, potentially within hours of application.	Can take a week or two to see significant pain improvement, though nifedipine may work faster than diltiazem.
Full Healing	Often prescribed for a course of 6 to 8 weeks. Some studies show healing in as little as 2 weeks for some, but longer treatment is common.	Treatment typically lasts for 6 to 8 weeks, with some protocols extending to 3 months or more.
Common Side Effects	Headaches are a very common side effect due to systemic vasodilation.	Less likely to cause systemic side effects like headaches, with localized irritation being more common.
Efficacy	Studies suggest healing rates of around 50-60% in chronic fissures.	Often show comparable healing rates to nitroglycerin, with some studies suggesting diltiazem may be preferred due to fewer side effects.

Lifestyle Adjustments to Aid Healing

Regardless of the type of ointment used, complementary lifestyle changes are essential for ensuring a successful outcome and preventing recurrence.

Increase Fiber and Fluid Intake: Softening stool is critical to avoid re-injuring the fissure during bowel movements. Eating more fruits, vegetables, and whole grains and drinking plenty of water helps regulate bowel function.
Use Stool Softeners: Over-the-counter stool softeners can be beneficial for managing constipation.
Take Sitz Baths: Soaking the anal area in warm water for 10 to 20 minutes several times a day can help relax the anal sphincter and promote healing.
Proper Hygiene: Gently clean the area after each bowel movement. Avoid using dry toilet paper, which can be irritating, and instead use wipes or a sitz bath for cleansing.

Potential Complications and When to See a Doctor

While most fissures heal with ointment and lifestyle changes, some require more advanced intervention. If symptoms do not improve after 6 to 8 weeks of consistent treatment, the fissure is considered chronic and may require further medical evaluation. Other signs that warrant a doctor's visit include persistent or worsening pain, severe headaches, or signs of an allergic reaction like severe irritation or swelling. Additional treatments, such as Botox injections or surgery, may be necessary for non-healing or recurring fissures.

Conclusion

How long does fissure ointment take to work depends on the specific medication and the individual's condition. While pain relief may be noticeable within days or weeks, the critical healing process that ensures long-term recovery takes approximately 6 to 8 weeks of consistent application. By following a healthcare provider's instructions, adhering to the full treatment duration, and combining ointment use with proper bowel management, patients can effectively treat their anal fissure and prevent recurrence.

Important Considerations for Ointment Application

Follow instructions carefully: Use the prescribed amount and frequency as directed.
Use gloves or finger cots: This ensures hygienic application and prevents absorption of medication through the skin on your hands, which is especially important with nitroglycerin.
Wait after application: Avoid having a bowel movement for a few hours after applying the ointment, if possible, to ensure it is absorbed properly.
Don't stop early: Even if pain subsides, complete the full course of treatment to prevent the fissure from recurring.

Frequently Asked Questions

An acute fissure is a new tear that has been present for less than 6 weeks and often heals on its own. A chronic fissure has persisted for more than 6 weeks and may require prescription medication, like an ointment, to heal.

Prescription fissure ointments, such as nitroglycerin and calcium channel blockers, work by relaxing the internal anal sphincter muscle. This action reduces painful spasms and increases blood flow to the area, which speeds up tissue repair.

No, it is crucial to complete the entire course of treatment, typically 6 to 8 weeks, even if your pain has subsided. Stopping prematurely is a common cause of relapse, as the fissure may not be fully healed yet.

The most common side effect of nitroglycerin ointment is a headache, which can occur due to the systemic vasodilation. Other potential side effects include dizziness, especially when standing up quickly.

Yes, ointments containing calcium channel blockers like diltiazem and nifedipine are associated with fewer systemic side effects, such as headaches, compared to nitroglycerin. Localized irritation may still occur, however.

If a fissure fails to heal after 6 to 8 weeks of consistent ointment treatment, it may be considered resistant. A doctor may then recommend alternative treatments, such as Botox injections to relax the sphincter or surgery.

Topical anesthetic creams, like lidocaine, can provide temporary pain relief but do not promote healing. Prescription ointments are typically required to relax the anal sphincter and facilitate long-term recovery for chronic fissures.