If possible, your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube (anoscope) to inspect your anal canal. However, if this is too painful for you, your doctor may be able to diagnose an anal fissure only by observation.
An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has the tear, as well as two separate lumps or tags of skin, one internal (sentinel pile) and one external (hypertrophied papilla).
The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn's disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition:
- Flexible sigmoidoscopy. Your doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer.
- Colonoscopy. Your doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea.
Anal 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.
Your doctor may recommend:
- Externally applied nitroglycerin (Rectiv), 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, which can be severe.
- Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief.
- Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms.
- Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects.
If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence.
Lifestyle and home remedies
Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences:
- Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually.
- Drink adequate fluids. Fluids help prevent constipation.
- Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure.
- Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear.
If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your child's doctor.
Preparing for your appointment
If you have an anal fissure, you may be referred to a doctor who specializes in digestive diseases (gastroenterologist) or a colon and rectal surgeon.
Here's some information to help you get ready for your appointment.
What you can do
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:
- Your symptoms, even if they may seem unrelated to the reason for your appointment
- Key personal information, including major stresses, recent life changes and family medical history
- All medications, vitamins or other supplements you take, including the doses
- Questions to ask your doctor
Take a family member or friend along, if possible, to help you remember the information you're given.
Some basic questions to ask your doctor include:
- What is likely causing my symptoms?
- Are there any other possible causes for my symptoms?
- Do I need any tests?
- Is my condition likely temporary (acute) or chronic?
- Are there any dietary suggestions I should follow?
- Are there restrictions I need to follow?
- What's the best course of action?
- What are the alternatives to the primary approach you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor may ask:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Where do you feel your symptoms the most?
- What, if anything, seems to improve your symptoms?
- What, if anything, seems to worsen your symptoms?
- Do you have any other medical conditions, such as Crohn's disease?
- Do you have problems with constipation?
What you can do in the meantime
While you're waiting to see your doctor, take steps to avoid constipation, such as drinking plenty of water, adding fiber to your diet and exercising regularly. Also, avoid straining during bowel movements. The extra pressure may lengthen the fissure or create a new one.
Your doctor will likely ask about your medical history and perform a physical exam, including inspection of the anal region. Often the tear is visible. Usually this exam is all that's needed to diagnose an anal fissure.
Aug. 18, 2017