Non-surgical treatment is usually the first recommendation, and doctors may treat anal fissures on an outpatient basis. Externally applied nitroglycerin is used to promote healing and increase blood flow in the fissure area, but there are side effects of the treatment, including headaches. Doctors may also use steroid creams to promote healing or Botulinum toxin type A (commercially known as Botox) to relax spasms in the anal muscle. Some blood pressure medications are also used to relax the area, while sitz baths, which are chemically treated soaks, are also used. In some cases, calcium channel blocking drugs are used to decrease constipation.
If those approaches don’t yield results in a reasonable amount of time or if symptoms continue to increase in severity, surgery is the next step. This usually involves a small incision in the anal sphincter muscle, with the goals of reducing spasms and pain and promoting healing. There is a danger of incontinence from cutting this muscle, but the risk is outweighed by the pain relief.
Post-Surgery Fissure Care
After surgery – or whatever treatment is recommended -- it is up to the patient to make changes that will avoid constipation issues in the future, particularly in the weeks following surgery. This means adding roughly 30 grams of fiber to the diet to keep stools soft. Fruits, nuts, vegetables and whole grains are excellent sources of fiber, and a fiber supplement may be added to that in the early stages of healing.
In addition to fiber, staying hydrated by drinking lots of fluids, avoiding strained bowel movements and particularly increasing blood flow by adding exercise are typical post-surgical recommendations. It is also wise to mention your previous condition to specialists before any examinations in the area.
These are habits that have to be maintained for life because the area of the initial anal fissure is now more susceptible to tears, and a lapse into an old lifestyle will put a patient at risk for future issues.