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The fastest way to heal anal pain

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Anal fissures can bring on a double whammy of embarrassment and discomfort. Here’s a look at the source of the pain and how to treat it.

Matt Villano

By Matt Villano

Bowel movements are a fact of life. But the severe pain caused by anal fissures doesn’t have to be. Thankfully, there are steps you can take to find relief and help yourself heal.  

First, what are anal fissures? They’re tiny rips or cracks in the anal canal. They have many causes, among them constipation, large bowel movements, childbirth, repeated diarrhea and conditions that reduce blood flow to the anus. In some cases, the fissures could be a sign of another condition, such as Crohn’s disease, according to the Mayo Clinic. (Think you might have irritable bowel syndrome? Here’s what to look for.)  

Anal fissures can be incredibly painful. Many people report that they make hemorrhoids — inflamed blood vessels in or around the anus — seem painless by comparison.  

“Nobody has ever died of a fissure, but it can be one of the more painful rectal conditions to experience,” says Mark Bazalgette, MD, a proctologist in Novato, California, who has specialized in anal fissures for nearly 30 years. “Fissures can bring grown men to their knees, and the pain can last for hours [after a bowel movement].”  

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Do anal fissures heal on their own?  

In some cases, yes, says Dr. Bazalgette. But not always.  

There are 2 kinds of fissures: acute and chronic. Acute fissures are the ones that may heal on their own, while chronic ones generally do not. A fissure is considered chronic if it lasts for more than 8 weeks.  

As Dr. Bazalgette explains, fissures cause “broken glass” pain because they are open wounds in a sensitive area. This pain triggers a spasm reflex, which in turn amplifies the pain and stops blood from reaching the injury. Without blood, the natural healing process is delayed. And the suffering is unlikely to end without intervention.  

“The cycle continues until you fix the underlying problem,” says Dr. Bazalgette. “Without doing that, anyone who has had an anal fissure once is more likely to get one again.”   

How do you find relief from fissures?  

One of the first steps is to stay ahead of constipation. To soften bowel movements, make sure you’re eating enough fiber. Good sources include fruits, vegetables, legumes and whole grains. Fiber supplements can help too. And you should drink plenty of water.  

In addition to improving your diet, it’s also important to exercise every day. The activity can help keep your digestive tract moving, says Dr. Bazalgette.  

In some cases, health care providers have their patients take stool softeners or periodic laxatives. (Download a coupon for the laxative Lactulose®.) And for years doctors have recommended sitz baths, which fit inside your toilet to wash your underside.  

The usual recommendation for a sitz bath is 15 minutes. Doing this twice a day can alleviate pain and improve healing, according to researchers at Creighton University in Omaha, Nebraska.    

It’s also important to honor the urge to use the bathroom. Holding in a bowel movement will ultimately make any constipation and pain worse, according to Alberta Health Services. For added relief, consider wiping with baby wipes or medicated pads, says the organization. (Learn more about coping with constipation here.)    

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What medications can help heal anal fissures?  

Anal fissures can be embarrassing to talk about with your health care provider, but just know this: They’re very common and can impact people of all ages and either gender. It’s important to keep your doctor in the know so that he or she can offer treatment suggestions.  

Some of the common medications used to treat fissures include over-the-counter creams such as Preparation H®, hydrocortisone or zinc oxide. For prescriptions, doctors often recommend Rectiv® (nitroglycerin), Xylocaine® (lidocaine) or Botox® injections, which temporarily halt anal sphincter muscle spasms.  

When is surgery recommended?

In severe chronic cases of anal fissures, doctors may prescribe surgery. The procedure is called a lateral internal sphincterotomy. While the term sounds scary, it’s a minimally invasive procedure that generally takes just 10 to 15 minutes.  

After applying a local anesthetic, your doctor will release pressure inside the anal canal by snipping the anal sphincter muscle. This enables healing by relaxing the area and allowing blood to flow freely. Afterward, both the sphincter muscle and the fissure usually heal within 8 to 10 weeks.  

Dr. Bazalgette says that the surgery is safe and runs little risk of infection. He adds that the biggest potential problem for patients recovering from a sphincterotomy may be a bit of anal leakage. But this only affects about 5% of patients, and it generally subsides after 2 or 3 months.  

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Additional sources  
Fissures and Crohn's disease: Mayo Clinic 
Caring for anal fissure: Alberta Health Services  
Comorbidities associated with anal fissures: BMC Gastroenterology. (2014). “The epidemiology and treatment of anal fissures in a population-based cohort”  
Sitz baths can alleviate pain: Clinics in Colon and Rectal Surgery. (2016). "Anal Fissure." 

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