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Treatment Options for Fissures

Have you had recurrent pain or bleeding during bowel movements for years?
You can literally feel sensitive anal skin tearing or it feels like you have broken glass in your stool? When these symptoms first appeared, you used an ointment or changed your diet to a high-fibre diet and things quickly got better. Maybe the problem even disappeared on its own.

How is anal fissure treated?

The treatment for an anal fissure may include:

  • Pain relief: Painkillers like ibuprofen or acetaminophen can provide relief from the discomfort.
  • Sitz baths: Soaking the affected area in warm water for 15 to 20 minutes several times a day can help to soothe the pain and promote healing. You can also soak your buttocks in 2 or 3 inches of warm water with Epsom Salts. This is called taking a “Sitz bath.” Sitz baths can be obtained over-the-counter from your pharmacist and helps relieve pain by relaxing the sphincter. If you find that a Sitz bath helps, do it 2 to 3 times a day for 10 to 15 minutes. Do not add soap, bubble bath to the water.
  • Fiber supplements: Increasing the fiber content in your diet with supplements like psyllium can help to soften stools and reduce the pressure on the anal area.
  • Topical creams: Over-the-counter creams containing numbing agents or nitroglycerin can help to relax the anal muscles, reduce pain, and promote healing.
  • Surgery: In severe cases, surgery may be required to repair the tear:

Excision of the anal fissure

The so-called fissurectomy removes the fissure and the surrounding inflammatory and scarred tissue in a triangular shape with a shallow incision. The goal of fissurectomy is to make a deep tear a shallow wound and remove scarring to enhance the anus’s elasticity. This results in a wound that may seem larger than expected. Freshening wound edges won’t prevent colonization of bacteria in the wound’s depth. Fissurectomy is performed under anesthesia to ensure patient comfort and the best possible overview. this can be accomplished with laser that may enhance healin. Local anesthesia may miss underlying issues like inflamed anal glands, hemorrhoids, or anal fistulas.

Prescribed medicine like nitroglycerin or nifedipine cream can relax the anal sphincter muscle and promote fissure healing. Apply the cream inside the anus twice a day as instructed by your doctor, even if you don’t have pain every day. This will ensure complete healing of the fissure.

If these steps to do not work in 1 to 2 months, doctors can try other treatments, such as:

  • Botulinum toxin (“BoTox”) – This is a shot that can help the anal sphincter muscle relax and heal. It can help, but it can also cause short-term problems with leaking of gas or bowel movements.
  • Surgery – During surgery, we can make a small cut in the sphincter while you are under sedation to help it relax. This surgery works in most patients (3/4) but we offer it only to people who do not get better with other treatments over 3-6 months. Surgery can cause lasting problems with very rare occurrence of leaking of gas or stool.

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