Anal Fissure

Treatment

Treatment of acute anal fissures aims to break the cycle of passing hard stools (or explosive diarrhea) and the resulting pain and spasms.

Doctors generally recommend self-care procedures such as:

• Soaking in warm water for 15-30 minutes to relax the anal sphincter muscle
• Consumption of additional liquids and fiber
• Stool bulking agents
• Acetaminophen for pain; but avoiding aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS), as they affect the blood's ability to clot and could delay healing
• Hand washing the area with soap and water after bowel movements

Anal fissures which don't respond to self-care and become chronic can be treated with medication or possibly surgery.

Medication

Nitroglycerin or nifedipine paste might be prescribed to apply around the anus a few times a day. The paste relieves pressure in tissue around the fissure and increases blood flow to promote healing. Temporary headaches or light-headedness from the paste are possible side effects.

Botulinum toxin injections into the internal sphincter muscle relaxes the anus and reduces spasms. The long-term effectiveness of this new treatment is still being studied.

Surgery

When self-care procedures and medication do not heal an anal fissure, surgery may be an option.

Lateral Internal Sphincterotomy

This is the more common surgery. "Lateral" refers to side, and "internal sphincterotomy" refers to the cutting of a small portion of the inner part of the sphincter muscle. While fissures usually occur in the back or front of the anus, cutting the sphincter muscle at the side is still effective in relaxing the anus and encouraging the fissure to heal without creating another wound near the fissure.

The surgery has a very high success rate with a very small risk for gas or stool incontinence or recurrence. It's usually an outpatient procedure, performed under general, regional or local anesthesia.

V-Y Advancement Flap

This surgery is much less common — perhaps 1 in 100 anal fissure surgeries. When a fissure has created extra tissue in the form of scarring or skin tags, the surgeon might perform the sphincterotomy at the fissure site and remove the fissure.

A v-shaped flap of skin is cut with the point of the 'v' at the fissure. After the cut is made into the internal sphincter muscle, the flap is slid to cover the wound and stitched closed. In patients with weakened sphincter muscles, the flap may still be made to cover the wound, but the sphincterotomy may be omitted.

The surgery is usually an outpatient procedure and performed under general, regional or local anesthesia.