Treatments aim to relieve pain and anal spasms, and to heal the fissure.

Home treatment

Basic preventive measures heal half of acute anal fissures.

– Consume enough fiber,

— Bdrink enough, be physically active,

– Avoid constipation, do not strain when going to have a bowel movement),

– Take a sitz bath 10 to 15 minutes, 2 to 3 times a day, will relieve pain and itching.

– Avoid soap and scented toilet paper as this can increase irritation.

– Use mild (non-irritating) laxatives such as mucilages, osmotic laxatives, or lubricants.

– Healing preparations based on vitamins or anti-inflammatory drugs are available in pharmacies, but these treatments have not shown superior efficacy compared to a simple lubricant.

– Suppositories that lubricate the anal canal and facilitate the passage of stool may be useful

– Paracetamol or an anti-inflammatory can relieve pain.

Medical treatments for an anal fissure

Besides basic treatments, doctors prescribe treatments to act on the cause of anal fissures when they become chronic due in large part to hypertonicity of the anal sphincter.

– Nitro derivatives such as glyceryl trinitrate (Rectogesic®) are effective against pain and improve healing at the dose of one application morning and evening for a month and a half. However, this type of treatment is often associated with headaches caused by systemic absorption of the drug.

– Calcium channel blockers are sometimes also prescribed. But these drugs do not currently have an official indication.

– The botulinum toxin (Botox®, Vistabel®, Dysport®, Xeomin or Neurobloc®) can be injected into the sphincter in order to relax the muscles where contracture occurs. By paralyzing the muscles, the toxin calms spasms and promotes healing. It is effective, but officially, the indication is not recognized in France for this type of treatment. However, this can prevent the need for surgery.

surgery

If symptoms have not resolved after 6 to 8 weeks of treatment, a surgery may be necessary. It is the most effective treatment for chronic anal fissures. The procedure called sphincterectomy, involves cutting part of the sphincter muscles to stop spasms and promote healing. The intervention is usually done as an outpatient surgery, without hospitalization. It heals in a few days. The risks ofanal incontinence permanent after surgery are minimal, but up to 45% of patients have mild anal incontinence in the days following surgery.