Anal Fissure Treatment

1. Most fissures can be treated without the need for surgery. With small, shallow anal fissures patients are advised to keep their stools soft and to avoid straining. This can be helped by taking a high fibre diet with plenty of fluids. The use of stool softeners can help. Warm baths and careful personal hygiene, especially after a bowel movement, can help to relieve pain and irritation. Some patients benefit from using haemorrhoid preparations either bought over-the-counter or prescribed by the doctor.

2. Fissures that do not respond to the simple measures above can be treated with creams that are specifically designed to relax the anal muscle and improve blood flow to allow healing. The creams used are GTN (rectogesic) or Diltiazem (Anoheal). Both can cause headaches and need to be used for at least 2 months to ensure healing.

3. Some fissures don’t respond to specialist creams. Botulinum Toxin (Bot Tox) has been used to bring about relaxation in the muscle. This involves a simple injection. Although now widely used Botulinum Toxin is not specifically licensed for treatment of fissures. Sometimes Botulinum Toxin injection can relax the muscles so much that patients can experience some leakage from the anus. This will recover after a few weeks.

4. For fissures that don’t heal with creams or Bot Tox injection, surgery may be required. This takes the form of a small cut made into the lowest part of the anal sphincter muscle. This is known as a sphincterotomy and is carried out under general anaesthetic usually as a day case. This is a very effective procedure but occasionally this operation can result in some loss of control and leakage. 

Updated 2016

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