Anal Fissure (cont.)
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Anal Fissure Medical Treatment
With anal fissures, there is a vicious cycle of constipation causing pain, which makes the anal sphincter muscles go into spasm. This causes more pain and spasms, that make having a bowel movement more difficult and worsens the constipation.
Initial treatments for anal fissures that are often very successful are designed to make the stool softer, easier to pass, and prevent constipation. Drinking more fluids and eating a high fiber diet may be supplemented by stool softeners and bulking agents. Occasionally laxatives may be used to help promote a bowel movement but their long-term use is not always appropriate.
The second approach to treatment involves decreasing the anal sphincter spasm. Often all that is needed are regular Sitz baths, sitting in a warm tub of water that allows the muscle to relax. Ointments are available and may be prescribed to help decrease sphincter spasm if basic treatments fail.
Botox injections into the internal anal sphincter paralyzes the muscle for up to three months and may be considered if routine treatments don't succeed or if there is intractable pain.
Surgery is another alternative for anal fissures. It is indicated for chronic anal fissures and potentially for acute fissures that don't resolve after a month of aggressive treatment.
Anal Fissure Medication
Medications for the treatment of anal fissures fall into two groups:
Anal sphincter muscle spasm control
Anal Fissure Surgery
Lateral internal sphincterectomy describes the procedure where the thickened internal sphincter muscle is incised to allow it to relax by releasing the tension within the circular muscle, and allowing the fissure to heal. The operation is usually performed under general or spinal anesthesia.
Sometimes, when a chronic fissure is present, the surgeon may elect to excise or cut out the fissure at the same time.
The pain of the anal fissure resolves almost immediately post operatively. Laxatives and stool softeners may be recommended for a few days after surgery. A high fiber diet is a lifelong recommendation to prevent recurrence.
Medically Reviewed by a Doctor on 11/7/2014
Bhupinder Anand, MD
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