Caused by trauma to the anus and anal canal due to bowel movement, anal fissure is a cut or tear occurring in the anus that extends up into the anal canal. Anal fissures are fairly common in men as well as women and can occur at any age including infancy. Symptoms of fissures include the patient suffering from anal pain that worsens with bowel movements. This pain may be bearable or severe in some cases. Sometimes the pain can also affect urination and cause discomfort while urinating, inability to urinate or frequent urination. To suggest an appropriate fissures treatment the doctor needs to first diagnose and evaluate the problem. This means the doctor will inspect the anus to confirm the presence of a fissure before suggesting a mode of treatment.
The goal of any anal fissures treatment is to break the cycle of spasm of the anal sphincter and discontinue its repeated tearing of the anoderm. In the case of acute anal fissures a large percentage of patients show speedy recovery and relief from pain by the use of medical therapy that is non-operative in nature. The treatment given to these patients involve adding bulk to the stool and softening the stool with psyllium or methylcellulose preparations and putting them on a high fiber diet. Also, the patients are advised to stay away from foods that may be difficult to digest well such as nuts, popcorn, chips, etc. They also need to increase their liquid intake to ensure the body has adequate fluids to take care of proper digestion. Some doctors may suggest Sitz baths after bowel movements to relax the spasm and increase the flow of blood to the anus.
Giving topical anesthetics and steroids to patients is also pretty common. Anesthetics like Xylocaine, pramoxine and tetracaine are recommended to reduce the pain of defecation. In some cases doctor may recommend oral medication to relax the smooth muscle of the internal sphincter, however the medication does little to actually heal the fissures. Some ointments such as Nitroglycerin, nifedipine, and diltiazem are used to relax the anal canal and increase blood flow, but come with a list of side effect that may be best avoided.
Two of the most successful types in anal fissures treatment are Chemical Sphincterotomy and Closed Internal Sphincterotomy. Chemical Sphincterotomy is a non operative and painless technique using botulinum toxin (BOTOX injection) to treat acute and chronic anal fissures. The injection of the toxin into the internal anal spincter basically paralyses the cavity and allows it to heal by not spasming. The effect of this treatment lasts up to about three months, in which time the fissure heals and the symptoms are resolved. On the other hand, Closed Internal Sphincterotomy is a Day Care Surgery which helps in reducing spasm and improving blood supply to the area to aid in healing.