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Symptomatic
Most anal fissures are shallow or superficial (less than a quarter of inch or 0.64 cm deep). These fissures self-heal within a couple of weeks. Furthermore, treatment used for hemorrhoid such as eating a high-fiber diet, using stool softener, taking pain killer and having a sitz bath can help.
Paediatric
Anal fissures in infants usually self-heal without anything more than frequently changing diapers and treating constipation if the cause.
Chemical sphincterotomy
Painful deep chronic fissures, on the other hand, will not heal because of poor blood supply caused by sphincter spasm. Traditionally surgical operations were required which are both painful and associated with various longterm complications, particularly incontinence in a small proportion of cases. Local application of medications to relax the sphincter muscle, thus allowing the healing to proceed, was first proposed in 1994 with nitroglycerine ointment, in 1999 with nifedipine ointment, and the following year with topical diltiazem. Branded preparations are now available of topical nitroglycerine ointment (Rectogesic as 0.2% in Australia and 0.4% in UK) and diltiazem 2% (Anoheal in UK although still in Phase III development).
Botulinum toxin injection, administered by colorectal surgeons, can also be used to relax the sphincter muscle and its use for this condition was first investigated in 1993. Combination of medical therapies may offer up to 98% cure rates, These medical treatments are used as first line therapy in treating chronic anal fissures, although a Cochrane Collaboration review of published research has questioned the effectiveness of medical treatments compared to surgery.
Surgical sphincterotomy
Surgical intervention may be required for persisting deep anal fissures unresponsive to the above conservative measures. Procedures include:
* Internal lateral sphincterotomy or excising a portion of the sphincter
* Anal dilation or stretching of the anal canal is no longer recommended because of the unacceptably high incidence of fecal incontinence
Despite the high success rate of these surgical procedures (~95%), there are potential side effects, which include: risks from anesthesia, infection, anal leakage or fecal incontinence.
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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