Fissure Treatment & Surgery

Anal fissure treatment can be a relatively simple process for most patients. Most anal fissures respond well to a simple at home treatment monitored by a physician.

Nitroglycerin Ointment

Approximately 80-85% of all anal fissures can be resolved with home treatments and the physician-supervised use of a topical medication such as nitroglycerin ointment.  This is the least invasive and least expensive remedy available.  Risks associated with nitroglycerin ointment may include headaches, lightheadedness, itching and burning. Nitroglycerin ointment should not be used in conjunction with erectile dysfunction medications (such as Viagra, Levitra, etc.)

If a chronic fissure fails to respond to our standard therapy with nitroglycerin or calcium channel blockers, two other options exist. Both of these methods specifically focus on relaxing the internal anal sphincter (the one we cannot consciously control).  The difference is whether it’s temporary or permanent.

Botox (Botulinum Toxin)

An injection of Botox into the internal anal sphincter can improve healing by temporarily paralyzing the muscle, which lowers resting pressure and reduces muscle spasms.  Risks may include pain from the injection, infection, hematoma (pooling of blood in the tissue) and temporary loss of control of gas or, more rarely, stool. The use of Botox is very effective, but the medication is very expensive, and so is typically used as a "second line treatment."

Surgery (lateral internal Sphincterotomy)

Lateral internal sphincterotomy is typically an outpatient surgery in which the surgeon makes a small incision in the internal anal sphincter.  Like Botox, this promotes healing by decreasing resting pressure and spasms, but the effects are permanent.  Risks may include pain, rectal bleeding, infection and a loss of control of gas or, more rarely, stool, which may be permanent (approximately 2 - 4% of the time). It is for these reasons, that this procedure is reserved for the most severe cases, or for patients who do not respond to the more conservative measures listed above.

To discuss anal fissure treatment with a physician, find a physician in your area.