Most fissures can be treated simply and heal within a few weeks. Many fissures will heal on their own without medical treatment. However medical treatment increases the success rate.
Ease and prevent constipation
Soft stools will be less likely to open the fissure and cause pain. Increase the fibre in your diet by eating more vegetables, fruits, wholegrain breads and cereals. Learn more about fibre in your diet.(external link)
You can also consider using commercially available fibre supplements such as psyllium (Metamucil and Konsyl D). These help by absorbing water into the stools (poo) in your bowel to soften them and improves the regularity of passing them. They are also called bulk forming laxatives. Learn more about bulk forming laxatives.
It's also important to drink at least 1.5 litres of fluid (ideally water) every day, unless your doctor advises you differently, eg, if you're elderly, or have kidney or heart failure. Using laxatives called stool softeners may also help to soften the poos. Read more about how to ease and prevent constipation.
Avoid straining during bowel movements
You can place your legs on a short stool while on the toilet to help relax the muscles around the anus. You can also take regular sitz baths (sitting in warm water up to the hips) to ease the pain and relax these muscles.
Maintain good hygiene
It's important to keep your anal area clean by washing gently with water after passing a bowel motion. Make sure to wipe gently after going to the toilet.
Creams or ointments
Pain relief: To relieve pain and discomfort when passing poos, your healthcare provider may prescribe a local anaesthetic cream or ointment. Using this before going to the toilet can make it more comfortable to go.
If the above measures don't help, your doctor may prescribe a cream or ointment to help relax your anal muscles. They also allow more blood flow into the skin to enable the fissure to heal. It's important to continue treatment daily for 4 to 6 weeks to allow the fissure to heal adequately.
- Glyceryl trinitrate cream (Rectogesic): This is usually the first option. This is funded by Pharmac if the fissure has been present for more than 6 weeks. Read more about Rectogesic.
- Diltiazem cream: This is another cream that could be prescribed. There's a charge for this as it isn't subsidised by the government.
Botox and surgery
Your surgeon could either give you an injection of Botox (botulinum toxin) or offer surgery. Surgery has the highest success rate of all treatments but has the highest risks and so is done as a last resort. The surgical options include making a small cut in your anal sphincter muscle (sphincterotomy), a skin flap (V-Y advancement flap), and cutting out the fissure (subcutaneous fissurectomy). The sphincterotomy is the procedure of choice for most people needing surgery.
For Botox and sphincterotomy, both methods relax the anal sphincter muscle, give pain relief and allow the fissure to heal. Sphincterotomy works best to manage anal fissure in the long-term compared to Botox but has a small risk of causing fecal incontinence (poo or gas leaking out unintentionally). Many people have mild incontinence immediately after surgery, but it's rarely permanent.
Some people are at high risk of incontinence after sphincterotomy, eg, if you've given birth to multiple children vaginally. In this instance your surgeon may recommend one of the other procedures.