Anal Fissure Treatment: Managing the Pain and Healing Process

Anal fissures are small tears in the lining of the anus that can be extremely painful. Left untreated, fissures may persist for weeks or months. Thankfully, there are various medical and lifestyle options available to help treat anal fissures and promote healing. This article provides an overview of anal fissure causes, symptoms, and the most effective treatment approaches.

Causes of Anal Fissures

While anyone can develop an anal fissure, they are most common in adults aged 20-40 years. The two main causes of anal fissures are passing hard stools and prolonged straining during bowel movements. Childbirth can also sometimes cause anal fissures in women. Having chronic constipation or diarrhea also increases the risk of anal fissures by making stool harder to pass.

Symptoms of Anal Fissures

The hallmark symptom of an anal fissure is sharp, stabbing pain during and after bowel movements. This is usually described as a tearing sensation. Some people also experience pain or discomfort between bowel movements. Bright red bleeding during or after a bowel movement is another common symptom. Swelling or lump formation around the anus may occur as the body tries to heal the tear.

Non-Surgical Treatment Options

Topical Nitroglycerin or Diltiazem Ointments
These ointments help relax and dilate the anal sphincter muscle, reducing pressure and pain during bowel movements. They can promote healing over 4-8 weeks in 50-80% of cases.

Stool Softeners & Dietary Changes
Fiber supplements, maintaining hydration, and avoiding constipation help produce softer stool that is less traumatic during bowel movements. Increased fluid intake and consuming fiber-rich foods are recommended.

Lifestyle Changes
Getting adequate fiber, staying well-hydrated, managing stress, and squatting rather than sitting on the toilet can help reduce pain and risk of re-tearing. Taking time for bowel movements is important.

Surgery for Chronic or Recurrent Anal Fissures

If conservative measures do not provide relief or an anal fissure recurs after healing, surgery may be required. The goal of surgery is to reduce pressure and spasms in the anal sphincter muscle. The two most common surgical procedures are:

Lateral Internal Sphincterotomy
During this minor operation, a small portion of the internal anal sphincter muscle is surgically cut to reduce pressure and spasms. This procedure has a 90% success rate in healing anal fissures but can sometimes cause flatulence or looser stool long term in 10-15% of patients.

Advancement Flap Surgery
This repair wraps healthy tissue from the buttock area around the anus and over the fissure site to promote healing. It has similar success rates to sphincterotomy but avoids risk of permanent loosening of the sphincter muscle. However, it requires general anesthesia and slightly longer recovery than sphincterotomy.

Managing Pain After Treatment

Minor pain, particularly when initially using topical medication or going to the bathroom, is normal after starting anal fissure treatment. Over-the-counter pain relievers and soothing creams can help manage discomfort. Applying ice packs and doing light stretching may also provide relief. Seeing improvements gradually over 4-8 weeks of nonsurgical treatment is a good sign healing is occurring. But contacting your doctor is important if pain persists or worsens.

Outlook and Prevention Tips

With proper treatment, the majority of anal fissures heal within 6-8 weeks. Recurrence rates without lifestyle changes are around 20-30%. Preventing constipation and maintaining gentle toilet habits long-term reduces the risk of new anal fissures developing. Combined medical management and lifestyle adjustments usually provide effective long-lasting relief from this painful condition.

Anal fissures can cause terrible discomfort but usually respond well to medical treatment and dietary and lifestyle modifications. While fissures may seem traumatic, various nonsurgical and surgical options exist to promote healing and reduce pain. With diagnosis and management guided by a healthcare provider, most people find relief from their symptoms. Adopting prevention strategies can also help avoid future anal fissures.

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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it