How is an anal fissure treated?
Often treating the constipation or diarrhoea can cure a fissure. An acute fissure is usually man-aged with dietary changes and local creams (non-operative treatments) which heals more than 90% of acute fissures. At least 50% of fissures heal either by themselves or with simple measures. A high fibre diet, bulking agents (fibre supplements), stool soften¬ers, and plenty of fluids help relieve constipation, promote soft bowel movements, and aide in the healing process. Increased dietary fibre may also help to improve diarrhoea. Warm baths for 10-20 minutes several times each day are soothing and promote relaxation of the anal muscles, which can also help healing. Occasionally, special medications may be recommended. A chronic fissure may require additional treatment.
A number of specific creams have come on the market over the last few years. These have been designed to reduce the spasm within the anal sphincter and can heal up to 80% of fissures. Some fissures, if they do not respond to these methods, may require an operation. The most commonly used ointments are:
- Rectogesic: (0.4 per cent GTN -(glyceryl tri-nitrate)). This may cause headaches if not used according to instructions. An information sheet on using GTN ointment for anal fissure is available here. Additional information is available on NHS choices website
- Anoheal (2% diltiazem cream). This is better tolerated although some patients develop skin irritation with the cream. An information sheet on using diltiazem cream for anal fissure is available here.