Best Treatment Plans for Painful Anal Fissures

Medically reviewed by: Gary H. Hoffman, MD

The Painful Anal Fissure.

An anal fissure is a small (or large) tear in the lining of the anal canal.  It is most often located in the posterior (back) of the anal canal.  Less commonly, it may be found in the anterior (front) portion. Rarely, the fissure, or fissures if they are multiple, may be located in other areas. The pain of an anal fissure is caused by exposed and irritated nerve endings that are located in the area of the fissure.

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The Pain.

The pain is exacerbated (made worse) if the fissure has become so deep that the muscle beneath the anal lining is exposed.  This causes the muscle to spasm, further aggravating an already painful situation.  It is at this time, when the pain (or bleeding) has begun, that patients usually seek the care of the proctologist, also known as a colon and rectal surgeon.  In Los Angeles and Beverly Hills, this may mean a visit to one of the surgeons of Los Angeles and Colon and Rectal Surgical Associates.

What Next?

After your proctologist has talked with you to understand the problem, a gentle exam will take place.  If you are too tender, only a visual exam will take place. Otherwise, you may have an anoscopy, whereby the doctor looks into your anal canal to visualize the fissure. You may also have a proctosigmoidoscopy to look at your rectum as well.

Once the diagnosis is made, treatments will be offered.  The following is a brief list of possible treatments:

  • Stool softeners.
  • Permanently discontinuing the use of all soap or soap products on the anal area.  You can clean with water or baby wipes if you do desire.  But, NO SOAP!
  • Hydrocortisone ointment may be applied to the anal area.  This is an anti-inflammatory agent
  • Diltiazim® ointment may be prescribed.  This is a smooth muscle relaxant which may be prescribed in order to relax the anal sphincter and allow or accelerate healing.
  • Nitroglycerin ointment.  This is also a smooth muscle relaxant.
  • Botox injections to temporarily paralyze the sphincter and help healing
  • A sphincterotomy.  This is an operation to relax the muscle by cutting a very small portion of it.

It must be stressed that each of the above therapies has potential side effects and must be discussed with your proctologist prior to their use.

Los Angeles Colon and Rectal Surgical Associates.

By calling (310)273-2310, you will be able to schedule a consultation that will hopefully put an end to your anal pain.  All of the surgeons at Los Angeles Colon and Rectal Surgical Associates are board certified and will speak with you in a confidential manner in an effort to relieve your pain and reverse your problem.

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