How is an Anal Fissure Treated?
It is important that symptoms be evaluated by a colon-rectal surgeon before you try self-treatment. A colon-rectal surgeon will perform a thorough examination and recommend treatment. The physicians at Connecticut Colon & Rectal Surgery, LLC develop an individualized treatment plan based on the symptoms you are experiencing and your physical exam. If your symptoms are mild, a nonsurgical approach may be advised. However, if your symptoms are severe, surgical intervention may be recommended.
Non-Surgical Treatment
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You do not have to live with the pain, treatment for anal fissures is highly effective. Your physician will properly diagnose an anal fissure, and work with you to resolve your symptoms by discussing the benefits and side effects of treatments.
Treatment includes:
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A high-fiber diet and over-the-counter fiber supplements to make stools soft, formed, and bulky.
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Over-the-counter stool softeners to make stools easier to pass.
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Drinking more water to help prevent hard stools and aid in healing.
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Warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day (especially after bowel movements to soothe the area and help relax anal sphincter muscles). This is thought to help the healing process.
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Medications, such as lidocaine, that can be applied to the skin around the anus for pain relief.
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Compound medications such as nifedipine or nitroglycerin ointment to relax the anal sphincter muscles which helps the healing process.
*Narcotic pain medications are avoided because they can cause constipation which could make the situation worse.
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Surgical Treatment
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Although most anal fissures do not require surgery, chronic fissures are harder to treat. If a patient is unresponsive to the conservative treatment options, surgery may be recommended. The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal. Surgical options may include a Botox injection into the anal sphincter or surgical division of an inner part of the anal sphincter (lateral internal sphincterotomy). Your colon and rectal surgeon will find the best treatment for you and discuss the risks of surgery. Both types of surgery are typically done as same-day outpatient procedures.
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Lateral Internal Sphincterotomy
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Lateral Internal Sphincterotomy is an operation to treat an anal fissure, a tear in the opening of the anus that can cause pain, itching, and bleeding. During this operation the surgeon starts by carefully inspecting the anal canal with a short, rigid anoscope. Once the anal fissure is identified, the operation may continue via an open approach. In an open approach, a small incision is made in the left or right side of the anal skin to expose the internal sphincter muscle fibers. The surgeon will then lift up the internal anal sphincter muscle and divide it using a knife of thermal cautery. Cutting the muscle relaxes the pressure in the anus and allows the fissure to heal. The surgery itself usually takes less than 30 minutes and is the most effective method for treating an anal fissure.
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If you believe you are suffering from anal fissures and want to relieve your discomfort, give our office a call at (860) 826-3880 to schedule an appointment or request an appointment online. If appropriate and availability allows, a consultation appointment will be scheduled for you to be seen by one of our experienced physicians, generally, within a two-week timeframe of contacting the office. Procedures are generally scheduled shortly thereafter.
