Anal Fissure Treatment Comparison

Approximately 90% of all anal fissures can be resolved with home treatments and the physician-supervised use of nitroglycerin ointment.  This is the least invasive and least expensive remedy available.  Risks associated with nitroglycerin ointment may include headaches, lightheadedness, itching and burning.

If a chronic fissure fails to respond to our standard therapy with nitroglycerin or calcium channel blockers, two other options exist. Both of these methods specifically focus on relaxing the internal anal sphincter (the one we cannot consciously control).  The difference is whether it’s temporary or permanent.

Botox (Botulinum Toxin)

An injection of Botox into the internal anal sphincter can improve healing by temporarily paralyzing the muscle, which lowers resting pressure and reduces muscle spasms.  Risks may include pain from the injection, infection, hematoma (pooling of blood in the tissue) and temporary loss of control of gas or, more rarely, stool.

Surgery (lateral internal Sphincterotomy)

Lateral internal sphincterotomy is an outpatient surgery in which the surgeon makes a small incision in the internal anal sphincter.  Like Botox, this promotes healing by decreasing resting pressure and spasms, but the effects are permanent.  Risks may include pain, bleeding, infection and a lifelong loss of control of gas or, more rarely, stool.

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