Q How is Anal Fissure treated?
least 50 percent of fissures heal by themselves without the need for an
operation. The longer that a fissure has persisted over time, the less likely
it will be to heal by itself. Oftentimes, acute fissures heal by themselves
spontaneously, with good anal hygiene consisting of a thorough cleansing after
each bowel movement. The use of sitz baths (soaking the anal area in plain warm
water for 20 minutes, several times a day) helps to relieve fissure symptoms,
but may not actually aid in the healing process. A topical hydrocortisone
preparation applied to the folds of the anal verge several times a day will
help to relieve symptoms and aids the healing process.
high fiber, well balanced diet, and encouragement of regular normal stools are
important in helping to heal the fissure. If pain is severe, an anesthetic
ointment can be introduced freely and frequently with the finger, utilizing
sphincterotomy has been attempted using a wide range of agents, including
nitric oxide and botulinum toxin. Since anal fissures are characterized by
spasm of the internal anal sphincter and a reduction in mucosal blood flow, the
aim of treatment is to relieve ischemia by reducing resting anal pressure and
improving mucosal perfusion.
has been shown that a local application of topical nitrates reduces anal
sphincter pressure and improves anodermal blood flow. This dual effect results
in fissure healing in more than 80% of patients. The principal side effect is
headaches in 20%-100% of cases.
has also been shown that a local injection of botulinum toxin near the fissure,
causes denervation, sphincter muscle weakness, and reduction of resting anal
sphincter pressure, which allows the fissure to heal. Fissure healing occurs in
more than 60% of patients. The principal side effect is incontinence of flatus
and or feces, which last for up to two months in 2% to 21% of cases.