Trauma or injury can stretch the anal canal and create a tear in the lining of the anus. These tears, known as anal fissures, usually come from passing large or hard stools. They can cause pain and bleeding during and after bowel movements.
The goal of treatment is to relieve pain and discomfort, and heal the torn lining. Acute anal fissures -- the ones that don't last longer than 6 weeks -- are common and usually heal on their own with self-care. Chronic anal fissures -- those that last longer than 6 weeks -- may need medicine or surgery to help them heal.
If your fissures are caused by constipation or diarrhea, you can change a few habits to help lessen the strain on the anal canal. These steps can help relieve symptoms and encourage healing in most cases.
- Stay hydrated. Drink plenty of caffeine-free fluids throughout the day. (Too much alcohol and caffeine can lead to dehydration.)
Eat a fiber-rich diet. To avoid constipation, your goal should be to get 20 to 35 grams of fiber every day. You can gradually increase the amount of fiber you eat by having more:
- Wheat bran
- Oat bran
- Whole grains, including brown rice, oatmeal, and whole-grain pastas, cereals, and breads
- Peas and beans
- Citrus fruits
- Prunes and prune juice
- Try fiber supplementsif you can’t get enough fiber from food. They can help soften stools and make you more regular. To avoid gas and cramping, gradually raise the amount of any fiber supplement you take until you reach the recommended dose.
- Over-the-counter laxatives may help if adding more fiber to your diet does not. Before taking any laxatives, ask your doctor what they suggest.
- Don't ignore your urge to go. Putting off bowel movements for later can lead to constipation; stools may become harder to pass and end up causing pain and tearing.
- Don't strain or sit on the toilet too long. This can increase pressure in the anal canal.
- Gently clean and dry your anal area after each bowel movement.
- Avoid irritants to the skin, such as scented soaps or bubble baths.
- Get treatment for chronic constipation or ongoing diarrhea.
- Sitz baths, or hip baths, can promote healing of an anal fissure. By soaking the rectal area in a tub of warm water -- two or three times a day for 10 to 15 minutes -- you can clean the anus, improve blood flow, and relax the anal sphincter.
These habits are usually enough to heal most anal fissures within a few weeks to a few months. But when they aren't enough, ask your doctor about other treatments.
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.
- 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. The dose is extremely low, so there is no risk of botulism poisoning.
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.