Most doctors can
diagnose an anal fissure from symptoms and by looking at the anus. Usually, the
doctor can see the fissure by gently separating the buttocks.
doctor may use a gloved finger (digital rectal examination) or a lighted
instrument (anoscope) to examine the fissure. But if the fissure is extremely
painful, the doctor will usually wait until it has begun to heal before
performing a rectal exam or using an anoscope (anoscopy) to rule out other
problems. A topical anesthetic may be used if an immediate examination is
During an exam, a doctor can also find out whether
another condition may be causing the fissure. If you have several fissures or
have one or more in an area of the anus where fissures usually do not occur,
you may have another condition such as
inflammatory bowel disease,
syphilis, a suppressed
HIV infection, or
anal cancer. Most fissures occur along the midline-the
top or bottom-of the anus.
How is it treated?
Most acute fissures need some
home treatment, including soaking in a shallow tub of warm water (sitz bath) 2 or 3 times a day, increasing fiber in the diet, and taking stool
softeners or laxatives. Some people find relief in a day or two of home
treatment. Although your pain may go away, it may take several weeks for the
fissure to heal completely. Sometimes fissures heal without treatment.
Try to prevent constipation, because it can keep a fissure from healing.
The pain of a fissure may make you anxious about having bowel movements. But
trying not to have bowel movements will only increase constipation and create a
cycle that keeps the fissure open and painful.
Drinking lots of
water or other fluids also will make stools softer and easier to pass.
You may want to use a nonprescription ointment such as zinc oxide,
Preparation H, Anusol, or 1% hydrocortisone to soothe anal tissues. But
evidence suggests that fiber and sitz baths help symptoms better than
nonprescription creams.1 Talk with your doctor about
whether you should use these medicines for a short period of time.
If a fissure lasts a long time, prescription medicine may help.
Prescription medicines used to treat anal fissure include nitroglycerin, high
blood pressure medicines, and botulinum toxin (Botox).
need to consider surgery if medicines do not stop your symptoms. The most
commonly used surgery is lateral internal sphincterotomy. In this procedure, a
doctor cuts into part of the internal sphincter to relax the spasm that is
causing the fissure.