An anal fissure is a tear or split in the perianal skin that can cause bleeding and painful bowel movements. These are usually caused by constipation or repetitive diarrhea. Approximately 80-90% of anal fissures will heal if the following measures are taken:
- Maintain a high fiber diet (25-30 grams) – You will be provided with a fiber information sheet. If you take a fiber supplement, it should be taken in the morning or afternoon (not before bed). Drink fiber supplements with plenty of fluids to reduce the chances of constipation.
- Sitz baths – This is a method to provide pain relief and speed the healing of the fissure. This involves sitting in a warm bath or shower, directed at the anal area. These should be done two to three times a day for 10 to 15 minutes. These can also be used to clean the anal area after a bowel movement to avoid further irritation caused from using toilet paper.
- Bowel habits – Avoid straining to have a bowel movement. The high-fiber diet should help soften the stool to make it easier to pass, reducing the need to strain. If increasing fiber does not soften the stool, try over-the-counter stool softeners (such as docusate sodium - Colace) and/or laxatives (milk of magnesia, mineral oil, magnesium citrate, or Miralax preferred). Diarrhea can worsen the fissure.
- Pain medications – Over-the-counter anti-inflammatory agents (example: Ibuprofen, Advil, Aleve, and Motrin) are the preferred medications to decrease inflammation and help with pain. Narcotic pain medications should be avoided because of the constipation they may cause, worsening the fissure.
- Cleansing – Try to avoid toilet paper as this will further irritate the area. Instead use sitz-baths/showers or gentle cleansing with a moist wipe for sensitive skin. Avoid wipes with fragrance as they typically have alcohol and can irritate you skin.
- Lidocaine 2% jelly – Lidocaine is a topical anesthetic that will numb the anal fissure, reducing symptoms. Lidocaine can be applied two to three times a day as needed.
- Nifedipine 0.2% ointment – Nifedipine may be prescribed for chronic fissures to decrease anal sphincter spasm; it improves blood flow to the area, healing the fissure. It is applied twice daily and takes at least 4 to 6 weeks to be effective.
- Neomycin hydrocortisone suppositories – One suppository inserted at bedtime for 2 weeks.
- Botox – Outpatient surgery treatment for patients in whom a lateral internal sphincterotomy may be risky.
- Sphincterotomy – A same-day surgical procedure to divide the portion of internal sphincter that is in spasm. This is performed after all nonoperative measures fail.
If you have any further questions or concerns, please call (314) 454-7177.