How are anal fissures treated?

The goal of anal fissure treatment is to lower the pressure on the anal canal by making stools soft, and to ease discomfort and bleeding. Conservative treatments are tried first and include one or more of the following:

  • Preventing constipation through the use of stool softeners, drinking more fluids while avoiding caffeine-containing products (which cause dehydration), and dietary adjustments (increase in intake of high fiber foods and fiber supplements);
  • Soaking in a warm bath (also called a sitz bath), 10 to 20 minutes several times a day, to help relax the anal muscles;
  • Cleansing the anorectal area more gently;
  • Avoiding straining or prolonged sitting on the toilet;
  • Using petroleum jelly to help lubricate the anorectal area.

These practices heal most fissures (80 to 90 percent) within several weeks to several months. However, when treatments fail and anal fissures persist or come back, other measures can be tried, including:

  • Using hydrocortisone-containing suppositories, foams, or creams to reduce inflammation;
  • Applying other creams and ointments. These may include a medicated cream (to help heal the fissure), a topical muscle relaxant (to relax the anal muscles), an anesthetic ointment (to reduce pain, if pain interferes with having a bowel movement), or nitroglycerin or calcium channel blocker ointments (to relax the anal muscles and increase blood flow to the region, promoting healing).
  • Injecting botulinum toxin type A (Botox) into the anal sphincter. The injection temporarily paralyzes the anal sphincter muscle, relieving pain and promoting healing.
  • Surgery

What does surgery for an anal fissure involve?

Before surgery is considered, your doctor will re-examine you and may conduct other tests to determine why other treatments have failed to heal the fissure.

A fissure may fail to heal because of scarring or muscle spasms of the internal anal sphincter muscle. Surgery usually consists of making a cut to a small portion of the internal anal sphincter muscle to reduce pain and spasms and allow the fissure to heal. Cutting the muscle rarely results in the loss of ability to control bowel movements.

The surgery can usually be performed on an outpatient basis (the patient goes home the same day). Pain is relieved after a few days and complete healing takes place in a few weeks.

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