The goal of anal fissure treatment is to lower the pressure on the anal canal by making stools soft, and to ease discomfort and bleeding. Conservative treatments are tried first and include one or more of the following:
- Preventing constipation through the use of stool softeners, drinking more fluids while avoiding caffeine-containing products (which cause dehydration), and dietary adjustments (increase in intake of high fiber foods and fiber supplements);
- Soaking in a warm bath (also called a sitz bath), 10 to 20 minutes several times a day, to help relax the anal muscles;
- Cleansing the anorectal area more gently;
- Avoiding straining or prolonged sitting on the toilet;
- Using petroleum jelly to help lubricate the anorectal area.
These practices heal most fissures (80 to 90 percent) within several weeks to several months. However, when treatments fail and anal fissures persist or come back, other measures can be tried, including:
- Using hydrocortisone-containing suppositories, foams, or creams to reduce inflammation;
- Applying other creams and ointments. These may include a medicated cream (to help heal the fissure), a topical muscle relaxant (to relax the anal muscles), an anesthetic ointment (to reduce pain, if pain interferes with having a bowel movement), or nitroglycerin or calcium channel blocker ointments (to relax the anal muscles and increase blood flow to the region, promoting healing).
- Injecting botulinum toxin type A (Botox) into the anal sphincter. The injection temporarily paralyzes the anal sphincter muscle, relieving pain and promoting healing.