A fissure is nothing more than a cut at the anal verge, or anal opening. The muscle beneath the fissure is very sensitive and is in a state of spasm due to the irritation. A cut in this area exposes the lining to the air and to the surrounding tissues and to anything that comes out of the anus, and it’s irritated chronically and very painful. There are many medical measures that we can use to help patients heal without an operation.
Some of the simple things are keeping soap away from the anal area. This doesn’t just go for the case where a person has an anal fissure. This should be always. You can keep the anal area clean with just water. Should the fissure not heal with simple measures, other things can be used, stool softeners can be added so that there’s not chronic tearing of the fissure, topical hydrocortisone ointments or creams which are anti-inflammatories can be applied to allow the fissure to heal. If this fails, there are other things that can be used such as Diltiazem.
Diltiazem is a medicine we use often to control blood pressure, but in the case of an anal fissure, it can be applied topically to relax the sphincter muscle. The sphincter is what surrounds the anal area and it is thought that a hypertonic sphincter or a sphincter that is in spasm causes much of the pain and keeps a fissure from healing. So, Diltiazem is applied by the patient three times a day, often this or the hydrocortisone will heal the fissure.
When all else has been tried, patients are offered two choices. Either the patient can live with the fissure and some people choose to, or the patient can undergo a lateral internal sphincterotomy. This operation has a high success rate and patients report feeling much better when the fissure has healed.
Your board certified surgeon at Los Angeles Colon and Rectal Surgical Associates can help you understand the various treatment options available for fissures. (310)273-2310