Most short-term (acute)
anal fissures can heal with home treatment in 4 to 6
weeks. Pain during bowel movements usually goes away within a couple of days of
Home treatment involves sitting in warm water (sitz bath) for 20 minutes 2 or 3 times a day, increasing fiber and fluids in
the diet, and using stool softeners or laxatives to have pain-free bowel
movements. Talk with your doctor about how long you should use
Sometimes, especially as they get older, people can develop little bulging pouches in the lining of the large intestine. These are called diverticula, and the condition is known as diverticulosis.
When the pouches become inflamed or infected, it leads to a sometimes very painful condition called diverticulitis. In addition to having abdominal pain, people with diverticulitis may experience nausea, vomiting, bloating, fever, constipation, or diarrhea.
Many experts believe that a low-fiber diet can...
Sometimes fissures do not heal with these remedies. A
fissure that has not healed after 6 weeks is considered long-term, or chronic,
and may need additional treatment.
Medicines are usually the first-line
treatment for chronic fissures.
nitroglycerin cream can reduce the pressure in the
internal anal muscle (sphincter) and allow the fissure to heal. A pea-sized dot
of cream is massaged into the fissure and the surrounding area. Do not use a
larger amount at one time, because this medicine can cause headaches,
lightheadedness, or fainting from low blood pressure. It is a good idea to
either wear gloves when applying the nitroglycerin cream or wash your hands
right after. The skin on your fingers can absorb the medicine and increase your
chance of side effects.
The calcium channel blockers
nifedipine and diltiazem also may help healing, also
by reducing the pressure in the internal anal sphincter. These two medicines are available as pills. Also, they can be made into a gel that can be massaged into the fissure and the surrounding area. The pill form of these medicines has more side effects than the gel form.
Botulinum toxin (Botox) may be injected
into the internal anal sphincter. Botox causes temporary paralysis of muscle,
which can reduce muscle tension and help the anal fissure heal.
Surgery may be done when more
conservative treatments fail to heal an anal fissure.
It is important to understand that, even with surgery, an anal fissure
must heal on its own. A sphincterotomy involves operating on the sphincter
muscles, not closing the actual fissure.
sphincterotomy has a better success rate than any medicine that is used to
treat long-term anal fissures. The results last longer, and fewer people have
anal fissures come back after surgery than after treatment with
In some studies, a greater
number of people who had lateral internal sphincterotomy had some inability to
control gas or stool (incontinence) after surgery compared to
people treated with medicine. Despite these results, satisfaction with this
surgery is high. And a review of many studies showed that the risk of
incontinence was 8%. This means that about 8 out of 100 people who had the
surgery had some problem with incontinence. But this rate was not very
different from the rates seen in people who were treated with medicine for
their chronic anal fissures.3