April 4, 2016
A good history usually makes the diagnosis. On examination there may be a skin tag also known as sentinel tag seen at the anal verge in relation to the fissure. Rectal examination is not usually tolerated by patients with anal fissure.
In a majority of the patients the fissure is self limiting and will heal by itself without any treatment.
Regular pain killers and keeping the motions soft with laxatives will help in the healing process. It is important to avoid very spicy food and pain killers which cause constipation. You should drink a lot of water as this will help to keep your motions soft.
If medical management fails, surgery provides excellent results with complete healing of fissure within a month.
Local anaesthetic ointments applied on and around the fissure may help to reduce the pain If the fissure is resistant to treatment with simple measures,
Muscle relaxing ointments can be used to help with healing. These ointments relax the muscles in the anus thus promoting blood supply to the anal skin and aids with healing of the fissure. These should taken only on the advice of a specialist.
Chronic fissures which are resistant to the above treatments should be treated by surgery. This is usually achieved by cutting small portion of the inner muscle around the anus (Internal sphincterotomy). These procedures are carried out in hospital under general or regional (spinal) anaesthesia. Surgery is the most effective treatment to date, but carries a very small risk of some degree of incontinence (of faeces or wind), although this may improve with time.