An anal fissure is a tear in the skin of the rectal area of the body. The tear often causes pain, especially during or after a bowel movement. It is possible for some anal fissures to heal on their own. Many fissure treatments — including Botox®, creams and sitz baths — are available for tears that do not heal naturally. When other anal fissure treatments are unsuccessful, surgery may be performed to heal the tear.
Constipation, Crohn's disease and chronic diarrhea can all cause anal fissures. A person will usually realize he or she has an anal fissure after experiencing excessive pain during a bowel movement or finding blood found on the toilet paper while wiping. Anal fissures also can cause itching or a small, rectal bump. If a person is experiencing pain or discomfort from an anal fissure, he or she should make an appointment with a gastroenterologist.
A doctor may start by recommending at-home anal fissure treatments for most patients. Taking a nightly sitz bath can help to heal an anal fissure. To do this, patients should fill a bathtub with warm water up to their hips and soak for about 20 minutes. Soaking in warm water helps to promote healing by relaxing the anal muscles, which may spasm as a result of the fissure and prevent sufficient blood flow to allow healing. Relaxing the muscles allows blood flow to improve, encouraging healing.
Prescription creams containing nitroglycerin also can help an anal fissure to health faster. Patients should wear latex gloves while applying the cream and follow their doctor's instructions regarding how much cream to apply each day. As of 2011, some medical professionals are using Botox® injections as an anal fissure remedy. Botox® can be injected into the internal anal sphincter, allowing the muscle spasms to calm down and the area to heal.
When other anal fissure treatments do not help a person to find relief, a doctor may want to perform outpatient surgery. The surgery involves the doctor making a small cut in the internal anal sphincter to relieve pressure and inflammation. Having this procedure performed is not an instant anal fissure fix. The patient will still need to take extra care with the anal area while the fissure and the incision heal.
People can avoid anal fissures by always eating a high-fiber diet. If a person is prone to constipation, he or she should speak to a doctor about taking laxatives or stool softeners to avoid getting an anal fissure. Drinking an adequate amount of water each day also can help to promote healthy bowel movements. Straining during a bowel movement is not normal. A person who constantly experiences straining every time he or she has a bowel movement should make a doctor's appointment as a preventive measure.