Like other small cuts or tears to the skin, an anal fissure will often heal by itself within a few weeks. However, you may require treatment to help ease the pain and discomfort that an anal fissure can cause.
It is important to see your GP if you have the symptoms of an anal fissure because it may be caused by an underlying condition. If this condition is not treated, your fissure may not be able to heal, and the problem will recur.
There are a number of treatments which can help encourage your anal fissure to heal, as well as easing your pain. These treatments are outlined below.
Also, because an anal fissure can make it very painful for you to pass stools, your GP will try and make the process easier for you by making sure your stools are soft. This will help you to pass them more easily, and with less pain and discomfort. Some of the ways that your stools can be softened are outlined below.
Laxatives
To keep your stools soft, you will normally be prescribed a laxative, which is a type of medicine which helps make your stools easier to pass.
Adults with an anal fissure will normally be prescribed a bulk-forming laxative. Bulk-forming laxatives work by helping your stools to retain fluid, making them softer and denser.
Children with an anal fissure will normally be prescribed an osmotic laxative. This type of laxative works by increasing the amount of fluid in your bowels, which helps stimulate your body to pass stools.
Once you start taking your laxative, your GP may have to adjust the dose until you find that your stools are soft and easy to pass.
Fibre
As well as using laxative medication, you should also increase the amount of fibre you have in your diet. Foods that are high in fibre include:
- wholegrain bread,
- brown rice,
- pasta,
- oats,
- beans,
- peas,
- lentils,
- grains,
- seeds,
- fruit, and
- vegetables.
Adults should be aiming to eat at least 18g of fibre a day. You can see how much fibre a food item contains by looking at the nutritional information on the back of the packet.
If you are increasing your intake of fibre, it is important to make sure you increase it gradually. A sudden increase can cause stomach cramps and make you produce more wind, leaving you feeling bloated. It is also important to make sure that you drink plenty of water. You should drink approximately 1.2 litres (six to eight glasses) of water a day, or more when exercising, or when it is hot.
Topical anaesthetics
A topical medicine is one which you apply directly to the affected area. Topical anaesthetics work by desensitising (numbing) the skin, helping to ease the sharp and severe pain that you may experience when passing stools.
The most commonly prescribed topical anaesthetic is lidocaine, which either comes in the form of a gel or an ointment. Lidocaine is usually used between one and two weeks, as your fissure should start to heal by this time. It is normally applied shortly before you pass a stool, but you should always follow the instructions that come with the medicine.
Analgesics
If you experience prolonged, burning pain after passing stools, you may be prescribed an analgesic (painkiller), such as paracetamol, or ibuprofen.
Always follow the dosage instructions on the packet. Ibuprofen may not be suitable for people with asthma, or those with stomach, kidney, or liver problems. It is also not suitable for pregnant or breastfeeding women. Your GP, or pharmacist, will be able to advise you about what type of painkiller is best for you.
Glyceryl trinitrate (GTN)
If your symptoms do not start to improve after a week, you may be prescribed a medicine called glyceryl trinitrate (GTN). This type of medicine will help your anal fissure to heal, easing your symptoms of pain. It comes in the form of an ointment, and is applied directly to the anal area, usually every 12 hours.
GTN is not suitable for pregnant or breastfeeding women. It is also unsuitable for children. Headaches are a very common side effect of this type of medicine. Approximately 50% of people using GTN will experience a headache. Some people may also feel dizzy or light-headed after using GTN.
You will normally have to use GTN ointment for between six to eight weeks, or until your fissure has completely healed.
Treating secondary anal fissures
If your anal fissure is being caused by an underlying condition, it is important that the condition is treated in order to help reduce the risk of your fissure recurring.
The treatment you receive will depend on what condition is causing your fissure. For example, if constipation is identified as the cause, you will usually be prescribed laxatives. STIs may have to be treated with a course of antibiotics.
Follow-up
If you have a primary anal fissure, your GP will normally arrange for you to have a follow-up appointment, approximately eight weeks after you started your treatment. This will allow them to check that your fissure has healed, or is showing adequate signs of improvement.
If your anal fissure has healed, your GP will advise you to continue eating a high fibre diet. If your condition has not been completely treated, your GP may recommend a further follow-up appointment six to eight weeks later, to ensure that you have responded to treatment.
If you have a secondary anal fissure, your follow-up appointment will depend on how well you are managing the underlying condition that is causing your fissure. Your GP will be able to advise you about when to make your next appointment.
Referral
If your anal fissure is particularly severe, or does not respond to treatment after eight weeks, you may have to be referred to a colorectal surgeon. A colorectal surgeon is someone who specialises in surgery on either your colon (the main part of you large intestine) or rectum (the final section of your large intestine that ends with your anus). If your wound does not heal, it may require surgery to help prevent infection and ease your pain.
