Anal Fissures are small minute tears in the anal mucosa that occur primarily due to chronic constipation (2, 3). When an individual passes large amounts of hard stool, then the sensitive anal mucosa gets torn due to extreme pressure being put on this region. This tear results in severe pain and bleeding and is medically referred to as Anal Fissure. Anal sphincter spasm is yet another feature of anal fissures.
Anal Fissure is quite a common condition and otherwise poses no threat to the overall health of the individual. Anal Fissure can be both chronic as well as acute. A detailedphysical examination is good enough to make a confirmative diagnosis although in some cases further more incisive investigations are required.
Anal fissures are subdivided into primary and secondary variants. The primary variant of Anal Fissure is the most common and can be treated easily through home treatments. The secondary variant of anal fissure; however, is rare but tends to be quite serious and requires medical management and at times surgery to treat it. Anal fissures are mostly seen in infants even though adults also get it at times.
Around 50% of the cases of anal fissures can be treated by just increasing fiber and fluid intake to soften the stools; however, in rare cases surgery is the preferred form of treatment especially if conservative treatments are deemed ineffective. This article highlights some of the treatment options available for anal fissures.
What are the Treatment Options for Anal Fissures?
As of now, there are no clear guidelines on how to go about treating anal fissures. Treatments can be both conservative and surgical for Anal Fissure. The primary aim of treatment of Anal Fissure is to stop the anal sphincter spasms and improve blood flow to the affected area. Once the blood flow is improved, it becomes easier for the anal tear to heal.
Conservative treatment is good enough for about half of the cases of anal fissure. The conservative measures include certain lifestyle changes like increasing fiber intake in the diet. This softens the stool and makes it easier for them to pass and thus helps faster healing of Anal Fissure. Cleaning the anal area with warm water relaxes the anal sphincter and helps in stopping the anal spasms.
If these lifestyle changes prove to the ineffective, then medication intervention becomes necessary for treating Anal Fissure. Some of the medications that are effective in treating anal fissures include:
Nitroglycerin for Treating Anal Fissure(4): Applying nitroglycerin rectal ointment is believed to be an extremely potent medication to treat not only the pain caused by anal fissures, but it also helps in improving the blood flow to the affected region promoting healing of the anal fissure. This is the most preferred form of treatment if home remedies and lifestyle changes are ineffective in the treatment of Anal Fissure. However, nitroglycerin ointment comes with a side effect profile of headaches that at times can be pounding.
Topical Anesthesia Beneficial in Treating Anal Fissure(5): There are several anesthetic creams like Xylocaine topical available in the market which are extremely effective in treating anal fissures. Anesthetic creams are excellent for pain relief caused due to anal fissures.
Treat Anal Fissures with Botox Injections(6): This is recommended in cases where other treatments to stop anal sphincter spasms are ineffective. Botox injections tend to paralyze the sphincter muscle and take care of the anal spasms thus promoting treatment and healing of the anal fissure.
Anti-Hypertensives can also treat Anal Fissures (7): There are also certain antihypertensive medicines like diltiazem or Procardia, which have been known to treat anal fissures.(7) They do so by relaxing the muscles of the anal sphincter. Both of these blood pressure medications can be applied externally in the form of ointment specifically to treat anal fissures, but also can be taken orally. Antihypertensive medicines are used when nitroglycerin alone is deemed ineffective for treating anal fissure.
Surgical Treatments for Anal Fissure: If all the above modes of treatment do not effectively treat anal fissures or if the symptoms of anal fissure start becoming intolerable, then the physician will recommend a surgical route. The surgical procedure to treat anal fissures is known as sphincterotomy.
In sphincterotomy for treating anal fissure, a segment of the anal sphincter muscle is resected to calm down the spasm and pain. Doing this surgical procedure, also promotes healing of the anal fissure. Various studies have confirmed the effectiveness of surgery in treating anal fissures; however, in some cases the procedure has led to fecal incontinence, but such incidences are quite rare.
In conclusion, there is no specificity when it comes to treating anal fissures in the literature. Majority of the cases can be treated at home by following simple lifestyle modifications like increasing fluid intake and taking in more fiber in the diet. Also, avoiding straining during bowel movements is another way to promote healing and calming down the symptoms of anal fissure.
If these measures are ineffective them medication management in the form of nitroglycerin ointment or antihypertensives are given for treating this condition. Despite all these measures, if there is no improvement of symptoms then surgery is the route to go. The surgery involves cutting a small portion of the muscle of the anal sphincter to relax the spasms and pain caused due to anal fissures.