Diagnosis
Your doctor will likely ask about your medical history and perform a physical exam, including a gentle examination of the anal area. Tears can often be seen. Usually, this examination is all it takes to diagnose an anal fissure.
An acute anal fissure resembles a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has a deeper tear and may have internal or external fleshy growths. A fissure is considered chronic if it persists for more than eight weeks.
Provides clues about the location and cause of the fissure. A fissure near the anal opening rather than the back or front is more likely to be a symptom of another disorder such as Crohn’s disease. If your doctor thinks you have an underlying condition, he or she may recommend further testing:
- Anoscopy. Anoscope is a tubular device that is inserted into the anus to help your doctor visualize the rectum and anus.
- Flexible sigmoidoscopy. Your doctor will insert a thin, flexible tube with a small video in the lower part of your large intestine. This test can be done if you are under 50 years old and there are no risk factors for bowel disease or colon cancer.
- Colonoscopy. Your doctor will insert a flexible tube into your rectum to examine the entire colon. This test may be done if you are over the age of 50 or have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea.
Treatment
Anal fissures usually heal within a few weeks if you take steps to keep your stool soft, such as increasing your fiber and fluid intake. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing.
If your symptoms persist, you’ll likely need further treatment.
Nonsurgical treatments
Externally applied nitroglycerin (Rectiv) to help increase fissured blood flow and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures have failed. Side effects can include headache that can be severe.
Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) can help with pain relief.
Botulinum toxin type A (Botox) injection to paralyze the anal sphincter muscle and relax spasms.
Blood pressure medications such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These drugs can be taken orally or administered externally and can be used when nitroglycerin is not effective or causes significant side effects.
Operation
If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small section of the anal sphincter muscle to reduce spasm and pain and promote healing.
Studies have found that surgery for chronic fissure is much more effective than any medical treatment. However, there is a small risk that surgery will cause incontinence.
Lifestyle and home remedies
Some lifestyle changes can help relieve discomfort and help the anal fissure heal, as well as prevent relapse:
- Include fiber in your diet. Eating about 25 to 30 grams of fiber per day can help keep stools soft and improve crack healing. Fiber-rich foods include fruits, vegetables, nuts, and whole grains. You can also take a fiber supplement. Adding fiber can cause gas and bloating, so increase your intake gradually.
- Drink enough fluids. Fluids help prevent constipation.
- Avoid straining during bowel movements. Strain creates pressure that can open a healing tear or cause a new tear.
- If your baby has an anal fissure, be sure to change diapers frequently, wash the area gently, and discuss the problem with your child’s doctor.
- If you have an anal fissure, you may be referred to a doctor who specializes in digestive diseases (gastroenterologist) or a colon and rectal surgeon.
By the way what can you do
While waiting to see your doctor, take steps to prevent constipation, such as drinking plenty of water, adding fiber to your diet, and getting regular exercise. Also, avoid straining during bowel movements. Extra pressure can lengthen the fissure or create a new one.
