Is there a link between Tamoxifen and anal fissures

Does anyone know of any links between Tamoxifen and anal fissures? I started taking Tamoxifen last February 2020 and 8 months later, I started getting tears/pain/blood when going to the loo. This kept repeating every 2 weeks but then has got more regular and painful. I’ve been to the Dr 3 times now, had blood tests (normal), poo sample (normal) and also had a sigmoidoscopy and nothing was found (thankfully). But I’m suffering really badly when going to the toilet - major pain (like pooing glass) and blood. Some days are better than others but mostly I’m in constant pain. I’ve been given Diltiazem but that doesn’t work. I am a healthy eater (lot’s of fibre/fruit/veg) and drink plenty of water and don’t strain when passing stools. Recently, I’ve been wondering if there is a link between Tamoxifen and anal fissures (although I have asked the Doc but they discounted it) and then I did the google search in desperation and I found a forum in the US where someone is suffering the same thing as me! I have since spoken to my breast care unit but they have said that there isn’t a link between the 2 and I can’t come off the Tamoxifen for a break. I really do feel that there is a link as the only thing that has changed in my life is taking this drug. There has to be something that is behind all this? I need to find a way to manage this and the pain if I have to keep on the Tamoxifen. Unfortunately this is now dominating my life now and I just want to get better and move on! Any advise would be gratefully received.

Hi Loxmeadow7

Thank you for taking the time to post on the Forum, and I’m sorry that you haven’t had a reply yet, hopefully someone will join the conversation soon. 

In the meantime, you may find it helpful to speak to one of our Breast Care Nurses on the free Helpline, 0808 800 6000. Alternatively, you can get in touch with our Nurses in the Ask Our Nurses area of the Forum and they can respond to you online.

Sending you my best wishes x

Hi Loxmeadow7,

I took Tamoxifen for around 6 years and went on to Anastrozole.  I found my stools very hard and therefore hard to pass, and suffered small cuts and pain/bleeding.  A nightmare at work in shared toilets!  This is probably flying in the face of sensible advice but my diet of mainly veg, pulses etc (lots of fibre) was probably a contributory factor. I started eating a slice of Soreen fruit cake every day and that helped soften stools and were easier to pass.

If I eat cake, chocolate and for example burgers and chips - it solved the hard stool problem!  I don’t eat them all the time but have incorporated them into my diet every now and again.  During treatment I ate mainly vegan and veggie diet but that was the downside…hard stools.

In terms of Tamoxifen, I do believe mysef that it affects your skin everywhere as it does inhibit estrogen, which therefore affects all of your body in some way.  After 10 years I’ve gone through a lot of difficulties with vaginal dryness (nightmare latterly), eczema, dry eyes and other sensitivities.  In the end, I thought those where bearable as I was (eventually) around 90% okay generally.  Last week I have been given the all clear and have no more drugs to take - hooray!  There is a tiny voice worrying what if the cancer comes back but the oncologist said taking these inhibitors too long can cause more problems.

When you are experiencing these various problems, they do drag you down a bit but I found that the Soreen helped with the cuts and fissures, dry eyes were helped with eye drops etc, vag dryness with conditioners when really bad and itchy and they all passed, came back, sorted and passed. 

I wish you all the best with your treatment - it’s a long haul to be sure but if you can somehow find ways to mitigate these painful problems they will begin to recede in your mind.

I think I maybe having the same situation. It just started almost 10.5 months after I started my daily routine on tamoxifen. I don’t have other problems with it yet. But this is something so different, I thought it was coming from my vaginal area. There’s for we will do a pelvic ultrasound. I don’t believe I have hemorrhoids Bc she never mentioned this at my last check up. With in one week, I have had four visible blood in my bowel movement and it’s towards the end push. I don’t really have regular constipation But lately I may have later movements more packed or back up. But nothing really worrisome. I have added fiber drink this week. I eat oatmeal often. It’s not a lot of blood but it did feel like a tear happened or something happened as I was pushing. When I wiped up it cleaned away in one wipe. It’s not a flow of blood. It’s red then pinkish. The first time I saw blood was the most, today it’s the least. It’s a spot in the anal rectum area bc when I wipe with my tissue today the blood that soaked up was literally the size of watermelon seed. And then nothing. 
I checked with a tampon to see if it’s coming from vaginal walls and I did not find any blood there. It has happened I will have light pink stains after sexual activity. That too started after tamoxifen. i will be talking to my team Drs and see what there take is on all this. I should get checked out closer for sure. How are you now? How does side effects get cured? Does anyone have suggestions? Would pure vitamin E oil help? People use it on scars. And women with hysterectomy are told to use in lower vagina area for dryness issues. Idk. Just a thought.

Hi there ,

I started tamoxifen feb 2021 and started having anal fissures by July . It’s on and off. I have started to change my diet , eat more veges/gluten free , no dairy but the bleeding is still there . I did call my oncologist but awaiting to see her . My obgyn suggest I take stool softener temporarily . 

OMG I am so glad to see this feed. I have exactly the same situation- healthy diet, lots of fruit, veg, nuts & seeds, I’ve been gluten free for 27 years. Bleeding started a few months after Tamoxifen- like it’s from a small cut. Then as time has gone on my stools have become small, round bullets- although ironically this means less stretching as I pass them. My GP tried three different treatments and eventually gave up and recommended laxatives. I have also now developed constant watery brown vaginal discharge (I have been referred to gyni). I don’t have any answers- but I can relate!


I am having the very same problem after taking Tamoxifen for around 4 months now. 
did you find any way to help with this awful problem? 
im feeling desperate! X 

Sad, but also relieved, to see that I’m not alone in this. My oncologist is amazing but has told me repeatedly since I began taking Tamoxifen that there is no link to that and my anal fissures. I began taking Tamoxifen a month before beginning an oral chemo for a year so initially I thought the chemo, or maybe the combination of the two, was the culprit. However, I finished my year of Lynparza and the fissures remained. I switched from Tamoxifen to Anastrozole, and the fissures remained. I switched back to Tamoxifen, and am still in the same boat.

Daily, I take stool softeners and miralax. This seems to manage the issue for the most part. Sometimes I like to pretend to be a scientist and I’ll stop taking one or both of those remedies… and the fissures return.

Has anyone else come across anything else that helps this issue? The only hope I have is that some day when I’m done taking Tamoxifen that everything will slowly go back to a state where I don’t have to take daily meds or suffer greatly, but at this point that hope is minimal.

Hi. Saw your post. I seem to have a similar issue. Has yours resoled? I started tamoxifen a few months ago and now have a fissure. My friend has recently had anal cancer so this has made me a bit anxious :grimacing: