About our e-newsletters
- Free e-newsletters
- Mayo Clinic expertise
- We do not share your e-mail address
Housecall, our weekly general-interest e-newsletter, keeps you up to date on a wide variety of health topics with timely, reliable, practical information, recipes, blogs, questions and answers with Mayo Clinic experts and more. Our biweekly topic-specific e-newsletters also include blogs, questions and answers with Mayo Clinic experts, and other useful information that will help you manage your health.
Housecall Archives
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
Treatments and drugs
By Mayo Clinic staffAnal fissures often heal within a few weeks if you take steps to keep your stools soft and treat constipation or diarrhea. If the tear doesn't heal within six to eight weeks, however, you'll likely need medical treatment or possibly surgery.
If your infant has been diagnosed with an anal fissure, change your child's diaper regularly and keep the anal area clean. Ask your child's pediatrician about strategies to prevent constipation and ways to keep your child from straining during bowel movements.
Nonsurgical treatments
If lifestyle and self-care measures — including adding more fiber to your diet, drinking more water, getting regular exercise and taking a stool softener — aren't effective, your doctor may recommend the following nonsurgical treatments:
- Fiber supplements. Taking a regular fiber supplement will help keep your stool soft and easier to pass, to avoid further irritation of the fissure.
- Sitz baths. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, will help relax the sphincter and promote healing. Don't use soap or bubble bath, as this may irritate the area.
- Medicated creams. Your doctor may suggest a rectal cream or ointment (Anusol-HC, zinc oxide, others) to help relieve discomfort from a mild fissure.
- Nitrogylcerin. Applying nitroglycerin ointment to the anus widens blood vessels and increases blood flow to the fissure, promoting healing. This therapy also helps reduce pressure in the anal sphincter, which eases the spasm and decreases pain. Side effects may include headaches, low blood pressure and dizziness. Your doctor may advise you to wear a disposable glove while applying nitroglycerin ointment, to remain seated or lying down, and to avoid exercise immediately afterward, to minimize side effects. Men shouldn't use nitroglycerin within 24 hours of taking erectile dysfunction medications, such as sildenafil (Viagra), tadalafil (Adcirca, Cialis) and vardenafil (Levitra), because of the possibility of significantly lowered blood pressure. You'll probably have to have nitroglycerin ointment custom formulated at a compounding pharmacy.
- Botox. Injecting a small dose of onabotulinumtoxinA (Botox) into the anal sphincter paralyzes the muscle for several months, causing the spasm to relax. Possible side effects include pain at the injection site or temporary, mild leakage of gas or stool (anal incontinence).
- Calcium channel blockers. The blood pressure medications nifedipine (Adalat) and diltiazem (Cardizem), taken orally or ground into a gel and applied to the fissure, also may help.
Surgery
If you have a chronic anal fissure that hasn't healed with other treatments, your doctor may recommend surgery. Surgery involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain and promote healing. Surgery is usually done on an outpatient basis.
- Gearhart SL. Diverticular disease and common anorectal disorders. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y.: McGraw-Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=2881328. Accessed July 28, 2010.
- Lacy BE, et al. Common anorectal disorders: Diagnosis and treatment. Current Gastroenterology Reports. 2009;11:413.
- Herzig D. Anal fissure. Surgical Clinics of North America. 2010;90:33.
- Greenwald DA. Common disorders of the anus and rectum: Hemorrhoids and fissures. American College of Gastroenterology. http://www.acg.gi.org/patients/gihealth/hemorrhoids.asp. Accessed July 28, 2010.
- Yamada T, et al. Anorectal diseases. In: Yamada T, et al. Textbook of Gastroenterology. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003. http://ovidsp.tx.ovid.com/sp-2.3.1b/ovidweb.cgi. Accessed July 28, 2010.
- Breen E, et al. Anal fissures. http://www.uptodate.com/home/index.html. Accessed July 28, 2010.
- Anal fissure. American Society of Colon & Rectal Surgeons. http://www.fascrs.org/patients/conditions/anal_fissure. Accessed July 28, 2010.
- Anal fissure. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec02/ch020/ch020.html. Accessed July 28, 2010.
- Gil J, et al. Screening for the effectiveness of conservative treatment in chronic anal fissure patients using anorectal manometry. International Journal of Colorectal Disease. 2010;25:649.
- Klein MD, et al. Surgical conditions of the anus, rectum, and colon. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/212152969-3/1032016749/1608/827.html#4-u1.0-B978-1-4160-2450-7..50343-1--cesec13_6840. Accessed July 28, 2010.
Find Mayo Clinic on