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Treatments and drugs
By Mayo Clinic staffAnal fissures are fairly common and usually heal without treatment or with nonsurgical treatments. Signs and symptoms may go away within two weeks. If the tear doesn't heal within six to eight weeks, however, you may need surgery.
For infants, the only intervention necessary may be changing the diaper regularly and keeping the anal area clean. Discuss with your pediatrician ways to avoid constipation and ensure regular bowel movements to prevent your baby from straining.
Nonsurgical treatments
If lifestyle and self-care measures such as adding more fiber to your diet, drinking more water, getting regular exercise, and taking a stool softener or occasional laxative aren't effective, your doctor may recommend the following nonsurgical treatments:
- Medicated creams or suppositories. Your doctor may prescribe a rectal corticosteroid (Anusol, others) or recommend an over-the-counter cream or ointment containing hydrocortisone (Cortaid, Preparation H) to help reduce inflammation and ease discomfort.
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Other nonsurgical therapies. Some doctors recommend applying nitroglycerine ointment to the anus, which widens blood vessels and increases blood flow to the tear, promoting healing. This therapy also helps reduce pressure in the anal sphincter, which eases the spasm and decreases pain, both of which promote healing. The dose of nitroglycerine is small to avoid dangerous side effects. Wash your hands thoroughly after applying the ointment to reduce the amount on your skin even further.
Side effects such as headaches, low blood pressure and dizziness may occur. Your doctor may advise you to remain seated or lying down and to avoid exercise immediately after applying nitroglycerin to minimize these side effects. Men shouldn't use nitroglycerine within 24 hours of taking erectile dysfunction medications such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) because of the possibility of significantly lowered blood pressure.
Another fairly new treatment involves injecting a small dose of botulinum toxin type A (Botox) into the internal anal sphincter. Botox paralyzes the muscle for up to three months, causing the spasm to relax. A possible side effect is temporary, mild leakage of gas or stool (anal incontinence).
Blood pressure medications nifedipine (Adalat) and diltiazem (Cardizem), taken orally or ground into a gel and applied to the tear, also have shown some promise.
Surgery
If you have a chronic anal fissure that won't heal on its own, your doctor may recommend surgery. Surgery usually involves cutting a portion of the anal sphincter muscle to reduce spasm and pain and promote healing. Surgery may also include removal of the fissure and any scar tissue resulting from it.
Surgery is usually done on an outpatient basis. Rarely, cutting the anal sphincter results in loss of ability to control bowel movements.
