Injury or trauma can cause a stretch in the anal canal, creating a tear in the anus lining. It is medically termed as anal fissure, and it occurs when hard or large stool is passed. The condition causes bleeding and severe pain after and during bowel movements. The majority of the anal fissure cases heal impulsively in as little as a few weeks without any medication attention or treatment.
Some patients suffer from a chronic and severe anal fissure that prolongs and bothers them for more than six weeks. The skin will be weak initially, causing the anal fissure to reoccur, especially when the root cause is not treated effectively. So, effective treatment is necessary.
Every anal fissure treatment aims to relieve the discomfort and pain while healing the torn anus lining. The acute fissures last less than six weeks and commonly heal with self-care. The chronic and severe fissures last more than six weeks and need surgery and medications to heal.
Self Care Methods
If the anal fissure is caused due to diarrhoea or constipation, it is easy to heal and relieve a few lifestyle changes. Different self-care methods aim to ease the discomfort and passing stools. These methods also help in skin healing to prevent anal fissure from occurring again. It helps the skin around the fissure to gain strength and make sure that the fissure doesn’t reoccur. Some of the self-care methods for anal fissures are:
- Increased intake of fibre-rich foods, including vegetables, fruits, whole grains with fibre supplements, if needed
- Going for bowels without delaying when there is an urge
- Keeping the body hydrated
- Avoiding alcohol and fragrance based products that come in contact with the anus
- Exercising for at least half an hour
- Avoid using drugs or medications that cause constipation
- Take mild laxative until the anal fissure heals
Pain Relief for Anal Fissure
The most common symptom of an anal fissure is chronic pain, especially when stools are passed. So, doctors always prescribe simple analgesics, including ibuprofen, to relieve the fissures’ pain.
The pain of bowel movements can be reduced significantly by soaking the anus lining when taking a hip bath with warm water. You need to soak it for two or three times daily so that the warmth effect can relax the sphincter muscles of the anus.
Patients must avail using soap on the anal lining as it causes soreness and irritation to the skin. Patients must use soft gauze and warm water to clean the area and take a sitz bath.
Medications for Treatment of Anal Fissures
In many cases of anal fissure, medications are prescribed by the doctors to alleviate the symptoms and promote healing.
Laxatives – Laxatives are prescribed to patients to increase the softness and volume of the stools. It softens the stool and promotes regular bowels, thereby preventing constipation, which causes anal fissure.
Glyceryl Trinitrate – Patients are also prescribed to apply an ointment with Glyceryl Trinitrate on the anus to widen the vessels and boost circulation. It promotes faster healing of the anal fissure.
Topical Anaesthetic Gel – You will need to apply it on the anus to make the area numb before passing larger or harder stool. It makes the spasm of muscles around the sphincter numb, which causes pain when passing stool.
Steroid Ointment – You should apply it on the anus to minimize the itching and swelling and help the person feel comfortable. It must not be used for more than one week.
Botulinum Toxin Injections – It is effective to numb the sphincter muscles in the anus and prevents muscle spasms for quick healing
Drugs to Block the Calcium Channels – Apply it on the anus topically to relax the sphincter muscles of the anus and promote healthy circulation of blood in the area.
Surgery for Anal Fissure
As mentioned, not all patients are required to undergo surgery to treat anal fissure. But, surgery is prescribed for chronic fissures, especially when other methods and treatments fail to show results.
Anal fissure surgery is the last option, which is very effective, and over 90% of the patients have reported positive results post-surgery. Surgery comes with a small amount of risk, including bowel incontinence. Different surgical procedures are used for treating anal fissure.
Lateral Sphincterotomy – It is the surgical procedure where small incisions are made in the sphincter muscles of the anus to minimize the muscle spasm. It also minimizes the risk of anal fissure reoccurrence and promotes healing.
Advancement Anal Flap Surgery – It is the surgical procedure where healthy tissues from the anal area are used to repair the fissure and allows the fissure to heal faster.
The pain caused by the surgical procedure is mild, and it hurts less than the anal fissure pain. Post-surgery the patients might experience a temporary inability to control gas bloating, infection, or mild faecal discharge. It takes around eight weeks post-surgery to heal the anal fissure completely.
The majority of the patients would need to follow-up with the doctors for several weeks after completing surgery, based on the severity and surgery used for treating fissure. The doctor will clarify it at the time of hospital discharge, and patients need to follow the instructions carefully for faster and healthy healing the fissure after completing the surgery.
Your healthcare provider will potentially decide to treat the fissure further and these decisions will depend on the severity of the case. The doctor evaluates the previous treatments, symptoms, and discomfort caused by the fissure and then decides if further treatment is needed for the condition.
Ongoing treatment and care are important for patients with severe and chronic anal fissures since there is a higher chance of recurrence of the fissure. So, patients are requested to seek medical attention if they are suffering from a severe fissure. Neglecting the conditions due to hesitation may make the fissure worse, causing more discomfort and pain later if left untreated. Don’t hesitate to discuss the condition to get the right treatment for fissure at the right time.