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Medications for Treating Anal Fissures

  • Nitrate ointment: Your doctor may prescribe a nitrate ointment to help increase blood flow to the anal canal. These ointments work to increase blood flow in the anal sphincter, which allows for better healing of fissures. Possible side effects include headaches, dizziness, and low blood pressure. Nitrate ointment should not be used within 24 hours of taking erectile dysfunction medications, such as Cialis, Levitra, or Viagra.
  • Calcium channel blockers: Calcium channel blockers are blood pressure-lowering medications. Topical calcium channel blockers are prescribed for treating anal fissures. Headaches can be a side effect of using these medications. Oral calcium channel blockers can also be taken for anal fissure treatment, although the rate of healing is typically lower and the occurrence of side effects higher.
  • Botox injections: When topical therapies aren’t effective, injecting botulinum toxin type A (Botox) into the anal sphincter is sometimes the next step in treatment. Botox injections temporarily paralyze the anal sphincter muscle, relieving pain and allowing healing to occur in between 60% to 80% of patients. Side effects can include temporary fecal incontinence and involuntary passage of gas. Recurrence of anal fissures has been shown to occur in about 42% of patients. Botox injections for anal fissures are still being examined in order to determine the best dosage, injection sites, and number of injections that are safe and healthy for treatment.

Anal Fissure Surgery

Surgery is usually reserved for anal fissures that have not healed with other forms of treatment. The surgery, called a lateral internal sphincterotomy (LIS), involves making a small incision in the anal sphincter muscle. As a result, pain and pressure are reduced, allowing the fissure to heal.

The pain from this procedure is typically mild and usually less severe than that of the fissure itself. The surgery may result in a temporary inability to control gas, mild fecal incontinence, or infection. But in the majority of cases, complete healing of fissures took place within 8 weeks after surgery.