An anal fissure is a small tear in the thin, moist tissue lining of the anus. Anal fissures are extremely common, especially in infants. In adults, fissures may result from constipation, which can cause tears and irritate the rectal lining. When a tear occurs, muscle fibers contract and spasm, making bowel movements difficult and preventing oxygen from reaching the tissues for healing. Treatment options range from over-the-counter medications to surgical interventions.
Corticosteroid Creams
Physicians often recommend over-the-counter medications to treat mild or small anal fissures. Most over-the-counter treatments are corticosteroid based to help reduce inflammation and ease discomfort. Several different brands are available, and patients should discuss with their physician which option is best.
Nitroglycerine Creams
Physicians may prescribe nitroglycerine-based creams to patients who have a larger fissure or who have fissures that seem to be healing improperly, according to the Mayo Clinic. Nitroglycerine cream is applied directly to the fissure and works by widening blood vessels and increasing blood flow to the tear, which promotes healing. Nitroglycerine cream also reduces pressure in the anal muscle, which eases spasms and decreases pain, further helping the healing process. Physicians keep dosages of nitroglycerine for anal fissures small to avoid the major side effects that nitroglycerine medications can have. Patients should wash hands thoroughly after applying the cream, as the medication is absorbed through the skin. Side effects of nitroglycerine can include headaches, low blood pressure and dizziness.
Botulinum Toxin
According to the Mayo Clinic, physicians are now turning to botulinum toxin type A, known as Botox, to treat anal fissures. Botox paralyzes the muscles for up to three months, causing the spasms in the anal muscle to relax. In some cases, this treatment may cause the temporary side effects of gas leakage or anal incontinence.
Surgery
According to the Medline Plus, physicians may recommend surgical intervention to treat fissures that won't heal. Surgeons most commonly perform this surgery in an outpatient treatment center under general anesthesia. Surgical intervention involves cutting a portion of the anal muscle to help reduce spasms and pain and promote healing. In some cases, surgery can involve the removal of the fissure and associated scar tissue. A rare side effect of cutting the anal muscle is loss of bowel control.
