Anal Fissure

For mild anal fissures, non-surgical treatments are recommended as the first step. These include dietary adjustments, increasing fibre intake, staying well-hydrated to avoid constipation, and using anti-inflammatory medications, pain relievers, or antibiotics to promote healing.

Lifestyle Adjustments
Simple lifestyle changes can help prevent constipation and promote healing:

• Drink six to eight glasses of water daily and consume high-fibre foods with regular exercise.
• Take daily showers or baths, and gently clean the area with baby wipes after bowel movements.
• Perform warm saline sitz baths regularly, for about 20 minutes each time, to clean and soothe the affected area.

Medication Treatment

Further medical treatment may be necessary if the fissure persists despite these measures. Using stool softeners with insoluble fibre can help maintain smooth bowel movements, and pain relief medications prescribed by a doctor can alleviate discomfort. Topical nitro-glycerine ointment may help relax the internal sphincter, reducing spasms. Additionally, botulinum toxin type A injections can temporarily relax the internal sphincter muscle. It is effective for 60-80% of cases and can be repeated. Combining botulinum toxin injections with nitro-glycerine ointment often yields better results than using either treatment alone.

⚠️ Please consult a doctor before using any medication to ensure targeted treatment.

If non-surgical methods fail to improve or heal the anal fissure, surgical intervention may be necessary. The primary goal of surgery is to relieve the fissure and promote healing. Standard surgical options include:

1. Lateral Sphincterotomy: This surgery involves partially cutting the internal anal sphincter (typically no more than one-third) to reduce muscle tension, relieve spasms, and aid healing. This procedure has a cure rate exceeding 90%, but around 3% of patients may experience long-term side effects, such as anal incontinence.
    
2. Anoderm or Rectal Advancement Flap Repair: An advancement flap repair may be required for chronic fissures unresponsive to other treatments. This procedure is suitable for patients with chronic fissures who have normal anal pressure and no spasms. During surgery, the fissure and associated scar tissue are removed, and a flap of skin (mucosa) with underlying muscle is used to cover the fissure site to promote healing.

⚠️ For chronic fissures lasting over six weeks, a biopsy may be performed to rule out potential causes such as Crohn’s disease or squamous cell carcinoma.