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Treatments and drugs
By Mayo Clinic staffAnal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing.
If your symptoms persist, you'll likely need further treatment.
Nonsurgical treatments
Your doctor may recommend:
- Externally applied nitrogylcerin, to help increase blood flow to the fissure and promote healing, and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache.
- Steroid creams, to help relieve discomfort.
- Botulin toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms.
- Blood pressure medications, which can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin in not effective or causes significant side effects.
Surgery
If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Surgery usually involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain and promote healing. Surgery has a small risk of causing incontinence.
- Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4160-6189-2..X0001-7--TOP&isbn=978-1-4160-6189-2&about=true&uniqId=229935664-2192. Accessed Oct. 16, 2012.
- Goldman L, et al. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-1-4377-1604-7..C2009-0-42832-0--TOP&isbn=978-1-4377-1604-7&uniqId=327451096-2. Accessed Oct. 16, 2012.
- Anal fissure. U.S. National Library of Medicine. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002116/. Accessed Oct. 17, 2012.
- Anal fissure. American Society of Colon & Rectal Surgeons. http://www.fascrs.org/patients/conditions/anal_fissure. Accessed Oct. 17, 2010.
- Zaghiyan KN, et al. Anal fissure. Clinics in Colon and Rectal Surgery. 2011;24(1):22.
- Etzioni DA. Current management of anal fissure. Seminars in Colon & Rectal Surgery. 2011;22:2.
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