Condition

You have been diagnosed with an anal fissure. This is a split in the sensitive skin at the anus. The pain from the split causes spasm of the anal sphincter muscle, which in turn decreases blood flow to the skin and slows healing. The trauma of having stool through a spastic sphincter causes further splitting, pain and spasm.

Goal of treatment

The goal of treatment is to reduce trauma to the split, relax the anal sphincter, decrease pain and improve blood flow to promote healing. It may take six weeks to heal an anal fissure.

Treatment

• Consistency and regularity of stool
  • Try to have one soft stool per day. This can be achieved with a high fiber diet, good hydration, bulk laxatives and stool softeners. Eat plenty of fresh fruits, vegetables and whole grain. Drink at least eight 8-ounce glasses of fluid (not including caffeinated beverages or alcoholic beverages) a day. Avoid acidic foods (tomato sauce, citrus) and spicy foods.
  • Take Citrucel (methyl cellulose), Metamucil (psyllium) or Fibercon (calcium polycarbophil), one tablespoon in a slurry or two capsules, three times a day with meals.
  • Take Colace (docusate) 100mg, one tablet, three times a day with meals.
• Sitz baths
  • Soak in a shallow tub of very warm water after each bowel movement for five to 10 minutes, and at least two to three times a day.
• Perianal skin care
  • Use pre-moistened wipes that DO NOT contain witch hazel or alcohol (NOT Tucks or Preparation H), such as baby wipes or Cottonelle. Do not use soap on the perianal skin.
• Topical sphincterolytic therapy
  • Apply Diltiazem Cream, 2 percent, ½ inch (marble size) amount to the perianal skin outside the anus twice a day. If it is wiped off after a bowel movement, reapply.