Anal Fissure Treatment: Relieving the Pain of this Common Condition
Anal fissures, which are small tears or breaks in the lining of the anal canal, are a common cause of sharp rectal pain during bowel movements. However, effective treatment options are available to help provide relief from the symptoms. This article outlines some of the main anal fissure treatment options and provides guidance on managing this painful condition.
What is an Anal Fissure?
An anal fissure is a small tear or cut in the lining of the anal canal. They most commonly occur just inside the anal opening and can cause sharp, burning pain and bleeding during bowel movements. Anal fissures are usually caused by trauma to the anal area from hard stools or constipation. They may also be caused by childbirth or other anal trauma. Left untreated, the pain from an anal fissure can significantly impact quality of life.
Conservative Treatment Approaches
For mild cases, conservative treatment options aimed at softening stools and relaxing the sphincter muscle may help promote healing. These include:
Stool Softener/Fiber Supplements: Taking a stool softener or fiber supplement can help decrease pressure in the anal canal during bowel movements by softening stools. This allows the fissure more time to heal without being aggravated.
Warm Sitz Baths: Sitting in warm water for 15-20 minutes several times a day provides soothing relief to the anal area. This helps relax sphincter muscles and increase blood flow for healing.
Topical Nitroglycerin/Calcium Channel Blockers: Applying a small amount of topical nitroglycerin or calcium channel blocker cream to the anal area helps relax the internal and external sphincter muscles, decreasing pressure and pain. This promotes healing in many cases.
Surgical Treatment: Lateral Internal Sphincterotomy
For cases that do not respond to conservative measures, a procedure called lateral internal sphincterotomy may provide longer lasting relief. This minor surgical procedure involves making a small incision in the internal sphincter muscle under anesthesia. By dividing a portion of the muscle, it reduces pressure in the anal canal, allowing the fissure to heal.
Research has found lateral internal sphincterotomy to be very effective for treating chronic fissures, providing relief of symptoms in over 90% of patients. While the recovery period takes 7-10 days, most patients find long-term relief without the need for additional procedures. Risks are minimal but may include a small risk of incontinence.
Alternative Surgical Options
Some alternatives to lateral internal sphincterotomy that may be considered include:
Botulinum Toxin Injections: Botox is injected into the internal sphincter muscle to weaken it temporarily, decreasing pressure at the fissure site. Additional injections are sometimes needed but it avoids incision. Effectiveness is around 60-80%.
Fissurectomy: Involves surgically excising the fissure edges. Provides relief in some cases but has higher recurrence rates than lateral internal sphincterotomy.
Anal Dilatation: Gentle stretching of the anal sphincter over several sessions aims to extend the fissure opening and promote healing. Less effective than other procedures and requires multiple visits.
Know When to Seek Treatment
Most anal fissures can be managed successfully with conservative treatments. However, it is important to see a doctor or specialist if:
- Bleeding increases or does not improve with 2-3 weeks of home treatment.
- Bowel movements become very painful or develop into diarrhea.
- A lump or swelling is noticed near the anal area.
- Fever or persistent anal discharge occurs.
With proper treatment, the majority of people get significant relief from the painful symptoms of anal fissures. Seeking medical attention ensures the best approach is followed to speed healing and prevent long-term complications.
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