Most cases of anal fissure heal spontaneously within a few weeks, without requiring treatment. However, some individuals may be affected by a chronic anal fissure that continues to plague them for six weeks or more.

Additionally, the newly healed skin is likely to be weaker for some time and the fissure may therefore easily recur, particularly if the cause of the fissure is not adequately treated.

Self-Care

There are several self-care techniques that can help to increase the ease of passing stools. These assist skin healing following the occurrence of an anal fissure. This helps the skin in the area to develop strength and prevent the recurrence of anal fissures.

Self-care tips to improve recovery for individuals with, or recovering from, an anal fissure, include:

• Increasing the intake of dietary fiber by consuming more fruit, vegetables and whole grains, with fiber supplements if necessary
• Staying hydrated by drinking sufficient water
• Having a bowel movement without delay when the urge presents
• Exercising regularly for at least 30 minutes each day
• Avoiding products containing fragrance or alcohol that will come into contact with the anus
• Avoiding medications which cause constipation
• Use a mild laxative regularly for a few weeks to allow the fissure to heal

Additionally, if there is a known cause of the anal fissure, such as constipation, this should be addressed to prevent recurrence.

Pain Relief

The most problematic symptom associated with an anal fissure is pain, particularly when passing stools.

Simple analgesics such as paracetamol or ibuprofen may be helpful in relieving the pain of an anal fissure. Additionally, the pain of passing stools may be greatly alleviated by soaking the region by sitting in a warm sitz bath regularly, like 2-3 times a day, so that the warmth can relax the anal sphincter muscles.

After going to the toilet, it is best to avoid soap on the anal region which could irritate the sore skin. Instead, use warm water and soft gauze to clean the area and follow it up with a sitz bath. Pat it dry with a soft cloth.

Other Medications

In some cases, other medications may be prescribed to relieve symptoms and improve healing. This may include:

• Laxatives: these may be bulking laxatives, which increase the volume and softness of the stools, or fiber laxatives. They help to soften the stools and to encourage regular passage of stools. They can thus prevent the constipation that may cause an anal fissure.
• Glyceryl trinitrate ointment may be applied to the anus to expand the blood vessels and increase blood flow, which encourages healing of the fissure.
• Topical anesthetic gel may be applied to the anus to numb the area before passing stools, to discourage spasm of the anal sphincter muscles which makes it more difficult and painful.
• Steroid creams applied to the area may reduce both severe swelling and itching, and help the patient become more comfortable. These should be used for no longer than a week.
• Calcium channel blocker drugs such as diltiazem can be applied topically to the anus to relax the sphincter muscles and increase the blood supply to the region.
• Botulinum toxin injections are useful to paralyze the sphincter muscles and prevent muscle spasms to improve healing.

Surgery

While most patients will not require surgery for an anal fissure, it is recommended for chronic cases when other methods have failed to bring about healing.

Surgery is very effective, with more than 90% of patients reporting positive long-term results. However, it is also associated with a small risk of complications such as bowel incontinence.

Several different surgical techniques may be used:

• Lateral sphincterotomy is a procedure which involves making a small incision in the sphincter muscles to reduce the muscle spasm, and therefore lower the likelihood of recurrence.
• Advancement anal flap procedure involves using healthy tissue from the anal region to repair the anal fissure.

Follow-Up

Most patients will require a follow-up appointment several weeks after treatment, depending on the severity of the anal fissure and the technique used.

Future treatment decisions, if needed, are made on a case-by-case basis, according to the symptoms and previous treatments of the patient. Ongoing care is important for severe anal fissures because the likelihood of recurrence is high.

References

• http://www.nhs.uk/Conditions/Anal-fissure/Pages/Treatment.aspx
• http://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/treatment/txc-20168258
• http://patient.info/health/anal-fissure
• https://www.nlm.nih.gov/medlineplus/ency/article/001130.htm
• http://emedicine.medscape.com/article/196297-treatment#showall