Our Treatment Method
It is important that an anal fissure heals completely the first time. Otherwise, the tear can re-open and cause recurring bouts of symptoms. Keep in mind that the tissue in this area takes significant time to regain its strength (three months for 40% of previous strength; two years for 80% of previous strength). As such, recovery can be a long-term process.
Our first-line, non-surgical treatment for anal fissures is a prescription ointment containing nitroglycerin. This ointment works by relaxing the anal sphincters (the two muscular rings in the anus) and lowering the resting pressure, allowing the edges of the fissure to come together and heal. It also increases the blood supply to the injured area.
For acute fissures, the ointment tends to promote a quick recovery. A chronic fissure that has been present for an extended period of time may require use of the ointment for several months, however. As some people experience headaches with nitroglycerin at the beginning, we use several formulas of varied concentrations to reduce side effects.
If you experience headaches, try to use less ointment more often (e.g. three or four times a day). Call the center if this approach does not seem to help. We can dilute the ointment further to find a level that’s appropriate for you. Unlike other healthcare providers, we don’t just prescribe standard concentrations and expect it to be appropriate for everyone. If headaches continue to be a problem we will recommend another ointment containing calcium channel blockers that also relax the internal sphincter muscle.
Given the prolonged weakness of the tissue following a fissure, care must also be taken to avoid constipation and straining during bowel movements for some time. To help, be sure to drink 7 to 8 glasses of water a day (50 ounces) and add two tablespoons of natural oat or wheat bran to your diet. (Metamucil, Benefibre, flax or other soluble fiber may be helpful as well.)
We also recommend that you not sit longer than two minutes on the toilet. If you can’t have a bowel movement in that time, come back later. This two-minute rule can help keep you from straining during bowel movements without realizing it. When traveling by air, stay hydrated, avoid alcohol, eat fiber and walk around when you can.
Fissures can become irritated by wiping, rubbing or scratching the area. Taking sitz baths (a warm tub with a tablespoon of ordinary salt added) or using a bidet can be soothing alternatives for cleaning the area and relieving itching. You may also want to purchase a softer, moisture-added toilet tissue.
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