Medications for Treating Anal Fissures
- Nitrate ointment: Your doctor may prescribe one of these to help raise blood flow to the anal canal and sphincter, which helps fissures get better faster. Some side effects may include headaches, dizziness, and low blood pressure. Nitrate ointment should not be used within 24 hours of taking erectile dysfunction medicines like sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra).
- Calcium channel blockers: These are blood pressure-lowering medications. Some of the topical ones can treat anal fissures, too. Side effects may include headaches. You can also take calcium channel blockers by mouth to treat anal fissures, although healing may be slower and the side effects more pronounced.
- Botox injections: When topical treatments don't work, injecting botulinum toxin type A (Botox) into the sphincter is sometimes the next step. Botox injections temporarily paralyze the sphincter muscle, relieving pain and encouraging healing in 60% to 80% of patients. You may not be able to control your bowel movements or passing gas, but it's temporary. Researchers are still reviewing Botox to figure out the best dosage, injection sites, and amount that is safe and healthy to treat anal fissures.
You probably won't need surgery for anal fissures unless other forms of treatment haven't worked. The surgery, called a lateral internal sphincterotomy (LIS), involves making a small cut in the anal sphincter muscle. It reduces pain and pressure, allowing the fissure to heal.
The pain from this surgery is usually mild. It hurts less than the fissure itself. The surgery might be followed by a temporary inability to control gas, mild fecal leakage, or infection. But in most cases, complete healing of fissures takes place within 8 weeks after surgery.