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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Bhupinder Anand, MD

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.

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