Pain during a bowel movement with blood in the toilet or on the tissue paper is an unpleasant experience. Many things can cause bleeding from the rectum including fissures, hemorrhoids or something more serious like cancer. It is important to seek medical advice to understand what is going on before beginning home treatment or when no improvement is noticed. Fissures in general are a harmless condition that can be treated at home.
Topical Anti-inflammatory
Because the fissure is a painful, inflamed ulcer or cut of the anal canal, it is helpful to apply topical creams or medications to ease the pain and swelling. Birth.com states that a non-prescription hydrocortisone cream or even topical vitamin creams are useful products to apply to the area. The hydrocortisone cream will help reduce pain and inflammation and the vitamin cream will help promote healing. Both creams can be used together or separately.
Nitroglycerin
Small and safe doses of nitroglycerin have been recommended by the Mayo Clinic to decrease spasm of the sphincter muscle and increase blood flow to the area, thus increasing the nutrients available to help heal the cuts and decrease pain. The Mayo Clinic states that this treatment is helpful, but there are several contraindications to using this method including not combining the treatment with the use of erectile dysfunction medications or in people with with regularly low blood pressure.
Botox Injection
More recently, botox, a powerful muscle paralyzer used in the treatment of wrinkles, has caught attention for its ability to relax the internal sphincter thus relieving pain and allowing for the fissure to heal. The Mayo Clinic states that the internal sphincter remains paralyzed for up to three months, and there is sometimes a temporary leakage of gas and stool during this time.
A study reported in the May 2010 "The Journal of Gastrointestinal Surgery" compared the used of different treatments for anal fissures. Different treatment options included two separate topical treatments, botox injection and surgery. During the course of five years more than 300 patients participated in the study. Results from the study found topical treatments relieved and resolved fissures only approximately 64 percent of the time while botox and surgery helped with symptoms 94 percent of the time. Surgery involving the removal of the fissure and had the highest rate of healing, but botox was a close second. The authors of this article recommended both botox and surgery as first-line treatment due to the high healing and low recurrence rate.
Fissurectomy
In severe cases, or cases that keep recurring, surgical removal of the fissure may be necessary. This process is called an internal fissurectomy, in which the cut and any scar tissue are removed. The Mayo Clinic states that in very rare cases cutting into the internal sphincter can result in incontinence. Even though the chance of incontinence is small, most doctors will choose a combination of the other treatment methods before surgery.
Lifestyle
Because fissures are usually caused by passing hard stools, eating a diet high in natural fiber, like fruits and vegetables, will help soften stools. When increasing fiber it is also important to increase the amount of water consumed so that the fiber will pass through the gastrointestinal system more efficiently. Getting regular exercise will improve circulation, promote healing to the fissure and encourage regular bowel movements. The Mayo Clinic indicates 30 minutes of moderate exercise at least four days a week is enough to cause these benefits.
References
- Mayo Clinic: Fissure Home Treatment
- Mayo Clinic: Anal Fissure Treatment
- "The Journal of Gastrointestinal Surgery" Conservative and Surgical Treatment of Chronic Anal Fissure: Prospective Longer Term Results.; Sileri P. et. al.; May 14th 2010.
- Birth.com: Treatment for Anal Fissures
