How Anal Fissure Is Treated

A break or tear in the anus is called an anal fissure. It can occur at any age but is more common in babies and children. The cause is usually constipation (hard stools), though there are other less common reasons a fissure can occur.

If constipation is the cause, treating that problem will be important to healing the fissure. Other treatments include home remedies such as sitz baths, topical and oral medications, injections, and surgery.

This article will discuss the various forms of treatment that may be used for an anal fissure. 

Home Remedies and Lifestyle

Home remedies can treat symptoms of an anal fissure or treat constipation if that's the underlying cause. These include:

• Avoiding wiping after bowel movements: Instead of using dry toilet paper after a bowel movement, it may help to find another way to keep clean. This can include using a bidet, a hand sprayer, or wet wipes.
  
• Dietary changes: If the fissure is caused by large or hard bowel movements, it may help to change your diet. Eating more foods that contain fiber may make stool softer and easier to pass. It's not always easy to change the diet or to know which foods are best for helping constipation. A consultation with a dietitian may be helpful. 
  
• Sitz baths: A sitz bath is essentially bathing the bottom in a shallow tub of warm water. A sitz bath that fits over the toilet bowl can be found in pharmacies and drugstores. It is filled with water, which slowly drains out of the tub and into the toilet. People can also try sitting in a few inches of water in the bottom of a clean bathtub.

Over-the-Counter (OTC) Therapies

There are no OTC therapies that will help heal the fissure faster, but there are some that may help ease the pain of bowel movements. These include:

• Fiber supplements: Fiber supplements can help make sure that stool is softer and easier to pass. There are several different types of fiber. It may take some time to determine which one will be most effective. Fiber supplements should be added to the diet slowly to avoid symptoms such as bloating and gas.
  
• Stool softeners: With a fissure, passing stool can be painful. A stool softener may ensure that stools are softer and therefore cause less pain when having a bowel movement. While stool softeners are available without a prescription, talk to a healthcare provider before you use them.

Prescriptions

Prescriptions for treating a fissure include:

External nitroglycerin: This might be the first treatment that’s offered. Nitroglycerin is applied topically to the anal area. It relaxes the muscles in the anal sphincter while increasing blood flow. More blood flow may help the tear to heal faster. 

Topical anesthetic: Technically, a pain reliever is not something that will help heal the fissure but may help by reducing pain. One such pain reliever that can be applied to the anal area is Xylocaine (lidocaine hydrochloride).

Botox injection: An injection into the anus with Botox (botulinum toxin type A) might be used in more serious cases. Botox works by stopping the muscles of the anal sphincter from having spasms. This may allow the tear to heal. 

Botox can be expensive and may cause a short period of incontinence (fecal soiling) in almost 15% of people. However, it may have fewer side effects than nitroglycerin, and the beneficial effects could last up to three months.

Calcium channel blockers: Medications used to treat high blood pressure (hypertension) might be prescribed for an anal fissure. They either are taken orally in pill form or applied topically as a cream. These drugs are usually prescribed after other treatments like nitroglycerin haven’t worked.

Some of the drugs that have been studied include Cardizem (diltiazem), Rogaine (minoxidil), and Procardia (nifedipine). There can be side effects such as itching or headache, but these drugs can be effective in healing a fissure.

Surgeries and Specialist-Driven Procedures

The fissure may become chronic when home treatments and topical or oral medications don’t work to heal it. Because it can cause pain and affect quality of life, healing a chronic fissure may mean considering pelvic floor therapy (where available) or surgery.

Pelvic floor physical therapy: Physical therapy may be used to treat some of the common problems, such as pelvic floor dysfunction, that may be present in people with a chronic anal fissure. This therapy is not currently recommended in the clinical guidelines for chronic anal fissure, however. 

A pelvic floor therapist is not easy to find and may not be covered by insurance. However, pelvic floor physical therapy might be used along with other therapies to treat chronic anal fissure and pelvic floor dysfunction.

Lateral internal sphincterotomy: Sphincterotomy surgery can be used to lower tension in the inner muscle of the anal sphincter. This anal muscle can’t be controlled consciously, so cutting it during a surgical procedure can reduce the tension and improve blood flow to the area. 

This surgery is usually successful, but it can cause temporary incontinence (loss of bowel control) or lead to other conditions such as bleeding or a perianal abscess (collection of pus in the anal area).

Fissurectomy: In a fissurectomy surgery, the fissure is surgically removed. This type of surgery is done less often than sphincterotomy. A fissurectomy tends to have more complications after surgery, such as incontinence. However, it is more effective in healing chronic fissures and preventing them from returning.

Anal advancement flap surgery: In this surgery, healthy tissue from another area of the body is used to heal the tear in the anal canal. This surgical technique may be associated with a lower risk of incontinence than sphincterotomy. However, the rates of complications and lack of healing may be about the same.

Summary

An anal fissure can be acute (sudden or short term) or chronic (long lasting). In many cases, an anal fissure can be treated at home and not recur. However, prescription medications or surgery might be used for a fissure that resists treatment.

A Word From Verywell

An anal fissure can be painful, but there are treatments to help heal them and prevent them from coming back. It's important to seek care from a healthcare professional to start the healing process and prevent a chronic fissure.