What is the treatment for an anal fissure?
Treatment of an anal fissure depends on how long the fissure has been present. Acute or relatively new fissures can usually be managed with a bulk-forming laxative, such as psyllium or senna, and a local anesthetic cream. These measures may help chronic fissures, but more intensive treatment is usually necessary. Nitroglycerin cream may be useful. However, a surgical treatment called a lateral internal sphincterotomy may be needed. This procedure divides the most superficial of the
two anal muscles and corrects any problems. It also allows easier passage of stool through the anal canal. The operation can be done using a local or regional anesthetic.
Treatment of anal fissures is divided into medical and surgical groups. Medical treatment of acute fissures is based upon topical creams, sitz baths, perirectal hygiene and dietary changes consisting of increasing fiber content. Most fissures can be treated symptomatically and heal over the course of several weeks (usually six). Conservative measures are taken to correct the problems that create the fissure. The consistency of the stools can be regulated with the use of increased fiber intake. Fiber has the property of absorbing water in the case of diarrhea or releasing water into the stools in the case of constipation, creating a more paste-like consistency. The increase in fiber intake can be accomplished with diet modification, use of fiber supplements or both.
Relaxation of the anal sphincter tone can be obtained with behavior modification. Also taking Sitz baths (soaking the anal area in warm water for 20-30 minutes several times daily) is an excellent way to relax the anal sphincter tone and increase the blood flow to the area to promote healing. Topical pain relievers, such as lidocaine jelly 2%, can be used to control the discomfort. If the six-week conservative approach has not successfully resolved the fissure(s) or if symptoms have worsened, other modalities of treatment or even surgery may be considered. Surgical intervention usually relieves the symptoms and a hospital stay is rarely necessary. Following surgery, the fissure heals over a 2-3 week period.
Surgical therapy is usually reserved for acute anal fissures that remain symptomatic after 3-4 weeks of medical therapy and for chronic anal fissures. Surgery usual consists of a small operation to cut a portion of the internal anal sphincter muscle. This helps the fissure to heal by decreasing pain and spasm. Cutting this muscle rarely interferes with the ability to control bowel movements and can usually be performed without an overnight hospital stay. |
