Anal Fissure Treatment: Relief from Painful Cracks and Tears
Anal fissures are small tears or cracks in the lining of the anal canal. They cause pain and bleeding during bowel movements. While they may heal on their own, advanced or chronic fissures often require medical treatment. This article discusses the various anal fissure treatment options available along with tips for prevention and relief of symptoms.
Conservative Treatment Methods
For most early or acute anal fissures, conservative treatment methods are usually recommended first before considering invasive procedures.
Diet and Lifestyle Changes
Making some simple diet and lifestyle alterations can help promote healing and provide relief. Increasing fiber intake through fruits, vegetables, and whole grains helps soften stools and reduces straining. Drinking plenty of water daily also keeps stools soft. Avoiding constipation is key, so staying hydrated and regular is important. Cutting back on caffeine and spicy foods that can cause diarrhea or irritate symptoms is also beneficial.
Stool Softeners and Suppositories
Over-the-counter stool softeners and bulk forming laxatives help reduce pain and bleeding from straining during bowel movements by softening stools. Glycerin or lidocaine-containing suppositories inserted in the anus after bowel movements provide temporary pain relief by coating the anal tissues.
Topical Nitroglycerin Ointment
Applying a small amount of nitroglycerin ointment just inside the anus before bedtime helps relax the internal anal sphincter and promote healing. The ointment eases pressure and pain from tightening during sleep. It improves blood flow to deliver oxygen and nutrients to repair tissue. Treatment usually lasts 4-8 weeks.
Alternative Treatments
Alternative therapies like Sitz baths, witch hazel compresses, or aloe vera gel applications provide soothing relief from symptoms. Some herbal supplements containing antioxidants, flavonoids and other plant compounds like horse chestnut, butcher's broom or calendula may aid fissure healing as well. Acupuncture and yoga poses that stretch the pelvic floor muscles are other complementary options pursued.
When conservative measures fail to produce significant relief or healing within 4-6 weeks, other types of minimally invasive anal fissure treatments may be considered next.
Minimally Invasive Treatments
For chronic or recurring fissures, procedures below the first line of treatment but aim to promote healing with less risk than surgery:
Botulinum Toxin Injections
Also known as Botox, botulinum toxin temporarily relaxes the internal anal sphincter muscle to reduce pressure and spasm at the fissure site. The localized paralysis allows the tear to rest and heal over 6-8 weeks. Multiple treatments may be needed and muscle control can be hampered for a short period after each session.
Lateral Internal Sphincterotomy
This quick office procedure involves making a tiny incision in the internal anal sphincter under local anesthesia. By partially dividing the tight band of muscle, pressure at the fissure site is relieved to aid mending. Continence issues are a potential risk but rare. Healing occurs within 4-6 weeks usually with one treatment sufficient.
When minimally invasive options fail or if extensive fibrosis is present, a more extensive surgery called fissurectomy may be considered.
Fissurectomy
This involves surgically exposing and completely excising the fissure along with any scar or fibrotic tissue present via a small anal dilation. The fresh tissue edges are then sutured back together to promote healing and regrowth of healthy tissue in the repair site.
Recovery takes about 4-6 weeks but has a high success rate of relieving symptoms permanently with one treatment. Risks include infection, incontinence or failure of the repair to seal completely which could lead to recurring fissures. It is usually reserved for chronic fissures that have not responded well to other methods.
Long-Term Management and Prevention Tips
Even after successful treatment, some chronic changes from long-term spasm and scarring are often not fully reversible. Adopting lifestyle habits permanently aimed at softening stools, relaxing pelvic floor muscles, maintaining regular bowel motions and avoiding constipation goes a long way in preventing anal fissure recurrences:
- Consume a high-fiber diet regularly and stay well-hydrated
- Consider fiber or bulking supplements if needed
- Exercise daily through walks, yoga or stretches if able
- Try relaxation techniques like meditation, breathing exercises
- Use soothing creams/ointments periodically for maintenance
- Consider biofeedback therapy for pelvic floor muscle re-education
- Seek medical advice right away if any new pain or bleeding arises
With proper treatment and lifestyle management, even chronic anal fissures can often find relief. In some advanced cases where other methods fail, surgery may be the most effective solution. Consulting a colorectal surgeon or gastroenterologist ensures selecting the safest and most tailored anal fissure treatment plan for a comfortable recovery.
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