A fissure is a small crack or tear in tissue, and its appearance depends on where it occurs. The most commonly searched type is an anal fissure, which looks like a tiny linear cut in the skin lining the anus. But fissures also develop on the heels, fingertips, and tongue. Here’s what each type looks like and how to tell them apart from other conditions.
What Anal Fissures Look Like
An acute anal fissure looks like a small, shallow tear in the moist tissue lining the anal canal. Think of it as a paper cut in a sensitive area. The tear is usually linear, running vertically, and may appear red or raw. In about 99% of men and 90% of women, the fissure sits at the back (posterior midline) of the anus. A smaller percentage appear at the front. You may not be able to see the fissure yourself depending on its exact location, but the hallmark sign is sharp, stinging pain during a bowel movement, sometimes with bright red blood on toilet paper.
Most acute fissures are superficial. The edges look clean, similar to a fresh cut, and the surrounding skin appears normal. At this stage, there’s no thickened tissue or lumps around the tear.
How Chronic Fissures Differ
When a fissure doesn’t heal within several weeks, it develops visible signs of chronicity that change its appearance significantly. The edges of the tear become thickened and raised (sometimes called “indurated margins”), giving the wound a more defined, crater-like look rather than a simple cut. The base of the fissure may deepen enough to expose the white muscle fibers of the sphincter underneath.
Two other visual markers often develop around a chronic fissure. A sentinel pile, which is a small skin tag that forms at the outer edge of the tear, can look like a fleshy bump near the anal opening. A raised bump of tissue called an anal papilla may also form at the inner edge. These features together give a chronic fissure a distinctly different appearance from the clean, simple tear of a fresh one. Discharge and intermittent bleeding are also common as chronic fissures repeatedly reopen.
Fissures vs. Hemorrhoids
Since both cause pain and bleeding, it’s easy to confuse fissures with hemorrhoids. The key visual difference is that hemorrhoids involve swollen veins, while fissures are tears in tissue. An external hemorrhoid looks and feels like a firm lump near the anal opening. A prolapsed internal hemorrhoid appears as a soft, bulging mass protruding from the anus. Neither of these looks like a cut.
A fissure, by contrast, produces no lump. If you feel sharp, cutting pain during a bowel movement but can’t feel any swelling or a bump near the anus, a fissure is the more likely cause. Internal hemorrhoids that haven’t prolapsed can bleed without pain, which is the opposite pattern of a fissure, where pain is almost always present.
What a Healing Fissure Looks Like
As a fissure heals, the wound gradually closes and the raw, red appearance fades. The most reliable signs of healing are the absence of pain during bowel movements and no more bleeding on toilet paper. You may notice itching around the area, which is a normal part of skin repair.
Once a fissure has fully closed, it sometimes leaves behind a small skin tag where the wound edges came together. This tag is harmless and simply a sign that scar tissue formed during healing. Chronic fissures that are in the process of healing may produce a small amount of discharge and cause itching as they close and occasionally reopen.
When Fissure Location Raises Concern
Fissures that appear off to the side of the anus rather than at the front or back midline are considered atypical. Multiple fissures at the same time are also unusual. These patterns can be associated with underlying conditions like Crohn’s disease, which causes inflammation in the digestive tract that makes the anal tissue more vulnerable to irregular tears. If a fissure appears in an unusual position or won’t heal despite treatment, further evaluation for an underlying cause is typically warranted.
Skin Fissures on Hands and Feet
Fissures aren’t limited to the anal area. Skin fissures commonly develop on the heels, between the toes, and on the fingertips, especially during cold or dry weather. These look like visible cracks or splits in the skin, similar to cuts but with rougher, more irregular edges. The surrounding skin is usually dry, and thickened or calloused tissue often builds up around the crack.
Skin fissures range from superficial to deep. Superficial ones affect only the top layer of skin and look like fine lines or surface cracks. Deep fissures penetrate further, exposing raw tissue underneath, and are more likely to bleed and cause significant pain. Heel fissures are especially common, often developing in rings of thick, yellowish callous around the rim of the heel.
Fissured Tongue
A fissured tongue is an entirely different condition, but the word “fissure” applies because the tongue’s surface develops visible grooves or cracks. The most common pattern is a single prominent groove running down the center of the tongue, with smaller grooves branching outward from it. Some people instead develop a crisscrossing pattern that divides the tongue surface into what looks like small islands or segments. Others have random grooves scattered across the top of the tongue with no clear pattern.
These grooves range from about 2 millimeters to 6 millimeters deep. A fissured tongue is generally painless and considered a harmless variation, affecting roughly 5% to 10% of the population. The grooves are most visible when the tongue is extended, and food debris can sometimes collect in deeper grooves, which may cause mild irritation if not cleaned.