What is the treatment for anal fissures?
Your doctor will usually recommend the following:
- Avoid straining at stool
- Keep bowel motions soft by drinking plenty of water, having a high fibre diet, taking fibre supplements, or laxative therapy if required
- Use hot salt water baths (Sitz baths)
- Avoid harsh toilet paper and use pre-moistened towelettes such as those used for babies.
If the above measures are not successfully then an ointment containing nitrates can be effective. These relax the anus muscle, reduce tearing, and allowing healing to occur. These ointments however frequently cause severe headache.
Chronic anal fissures frequently require intervention to allow complete healing. Interventions include:
- Botox injection. Botulinim toxin is injected into the anus muscle resulting in temporary relaxation that can lead to complete healing. In a few months the anus muscle is as strong as ever. Botox can be injected safely more than once. The most frequent side effect is itch and temporary incontinence of flatus (wind).
- Surgery (sphincterotomy). A surgeon can cut through the anus muscle at another spot to allow the fissure to heal. This is reserved for patients who fail to find relief with the above measures. There are long term side effects of sphincterotomy. Some people can become incontinent of stool after having had sphincterotomy.