Anal Fissure Treatment

It is important that an anal fissure heals completely.  Otherwise, the tear can re-open and cause recurring bouts of symptoms.  Research has shown 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 nitroglycerin ointment, which relaxes the anal sphincters, lowers the resting pressure and increases blood supply. As some people experience headaches with nitroglycerin initially, we use several formulas of varied concentrations—or a customized dilution—to reduce side effects.

For acute fissures, nitroglycerin 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.  If patients experience headaches, we recommend using less ointment more often (e.g. three or four times a day). 

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.  We advise patients 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 works too.)

We also recommend that patients not sit longer than two minutes on the toilet, as we find this two-minute rule can help prevent from straining during bowel movements.  When traveling by air, we instruct patients to stay hydrated, avoid alcohol, eat fiber and walk around when they can.

Fissures can become irritated by wiping, rubbing or scratching the area.  Accordingly, other recommended supplemental care includes taking sitz baths (a warm tub with a tablespoon of ordinary salt added) or using a bidet as alternatives for cleaning the area and relieving itching.

Next: Treatment Comparison