An anal fissure is a medical condition in which there is a tear in the lining of your lower rectum due to trauma or injury that caused your anal canal to stretch. An anal fissure can be caused by a lot of things among which are anal sex, defecation of large and dry stool, constipation, repeated diarrhoea, the process of childbirth and a condition known as Crohn's disease.
Although anal fissures might be common during infancy, older adults are also prone to anal fissures due to decreased blood flow in the anorectal area. This is to say that anal fissure affects both the old and young especially the young people and immunocompromised individual. During and after childbirth, women are at risk for anal fissures due to straining during delivery. People with IBD also have a higher risk of developing anal fissures. The inflammation that occurs in the intestinal lining makes the tissue around the anus more prone to tearing.
Any person with anal fissure or knows someone with anal fissure aims to know how to treat it so they can heal the torn linings of their anus and relieve themselves from pain and discomfort. In this article, I will be guiding you through ways you can treat an anal fissure.
The first treatment to start with when you notice that you have an anal fissure is self-care. Self-care treatment is more effective in treating acute anal fissure. An acute anal fissure is the most common anal fissure type, and it is usually due to constipation or diarrhoea. Unlike the other types, acute anal fissure doesn't last longer than six weeks and can quickly heal on its own with self-care. The things listed below are self-care treatments that effectively relieve anal fissure symptoms and encourage healing within a few weeks or months.
● Drink caffeine-free fluids to stay hydrated throughout the day.
● Include 20 to 35 grams of fibre to your diet daily to help avoid constipation. Fibre-rich foods you can include in your diet are fruits, vegetables, peas and beans, prunes and prune juice, wheat bran, oat bran, nuts, and whole grains.
● If you are not able to include up to 20 to 35 grams of fibre to your daily diet, start taking fibre supplements like Benefiber, Citrucel, or Metamucil every day.
● If including more fibre to your diet is not beneficial, try taking over-the-counter laxatives. But, ensure that you ask your doctor for his/her suggestion on which laxative to take.
● Ensure that any product you use that might come in contact with your anus does not contain fragrance or alcohol because it can lead to discomfort or itching.
● When you want to clean your anus after a bowel movement, make sure you do not use toilet papers. Use only baby wipes or medicated pads.
● Get treatment for chronic constipation or ongoing diarrhoea.
● Avoid putting off your bowel movements for later because it can result in constipation.
● Do not strain or sit on the toilet for too long because that can increase pressure in your anal canal.
● After each bowel movement, ensure that you clean and dry your anal area gently.
● Try sitz baths because it helps treat anal fissure by improving your blood flow, cleaning your anus, and relaxing your anal sphincter. Sitz baths involve soaking your rectal area in a tub of warm water two to three times in a day for about 10 to 15 minutes.
Anal Fissure Medication Treatment
You are to use medicines only when you have a chronic anal fissure or when the self-care treatment doesn't work. There are different medications your doctor can recommend to you. Some of which include:
There are two different types of laxatives you can use when you have anal fissure — bulking laxatives and fibre laxatives. Bulking laxatives help increase the volume and softness of the stools. Fibre laxatives on the other hand help in softening your stool and also in encouraging the regular passage of stools. Laxatives not only helps in treating anal fissure but also helps in preventing constipation that later leads to an anal fissure.
Nitrate ointment might be prescribed to you by your doctor because it helps in increasing blood flow to both your anal canal and anal sphincter. Do not take this treatment if you are currently on any erectile dysfunction medications like sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra). Some of the side effects you are likely to experience when using nitrate ointment are headaches, dizziness, and low blood pressure.
Calcium Channel Blockers
It is well known that calcium channel blockers are a good medication to take to aid reducing blood pressure. Although, the topical calcium channel blockers are very effective when used as a treatment for anal fissure. The topical calcium channel blockers are typically applied to the anus directly. Some of the side effects you are likely to experience when you're on the topical treatment are headaches, dizziness, and itching.
When topical treatments end up being ineffective, the next option is to inject botulinum toxin type A (also known as botox) into the anal sphincter. The good thing about the botox injection is that there is no risk of getting botulinum poisoning because the dose given to patients on a normal basis is typically low. After taking the botox injection, it will temporarily make you unable to control passing out gas and bowel movements. That is because the botox injections normally paralyze the sphincter muscle temporarily, thereby relieving pain and encouraging healing.
When all other treatments (self-care or medicine) fail to work or have a chronic anal fissure, surgery is the best treatment option. The surgical procedure (Lateral Internal Sphincterotomy (LIS)) for treating anal fissure involves making a small cut in the sphincter muscle. During the surgery, you'll only feel a mild pain because compared to the anal fissure, it is less painful. After the surgery, the side effect is a temporary inability to control gas and mild faecal leakage or infection. It takes about eight weeks for the anal fissure to get completely healed after the surgery.