Having an anal fissure can be a daunting experience especially if it has recurred severally.
Studies have shown that approximately 3,42,000 new anal fissure cases occur every year in the United States where the main affected are young and middle-aged people with an equal female to male ratio[1].
Many affected people want a permanent cure for their anal fissures. You should know that apart from conservative treatments, there are surgical and non-surgical procedures that can help cure your fissure permanently.
Before we think about curing fissure permanently or even discuss how to cure fissure, we will need to be able to diagnose anal fissure!
Easy Diagnosis of Anal Fissure
An anal fissure can be diagnosed by:
- Physical examination of the fissured area.
- Inspection of the anus and rectum with an anoscope.
- Flexible Sigmoidoscopy: This involves your doctor inserting a thin, flexible tube with a tiny video into the bottom portion of your colon. Patients less than 50 years and at lower risk of colon cancer are more suited for this test.
- Colonoscopy. Here, the doctor will insert a flexible tube into your rectum to inspect the entire colon. This is most suited for patients above 50 years who have a higher risk of developing colon cancer or other intestinal conditions.
How is An Anal Fissure Treated Permanently ?
The primary objective in the treatment of anal fissures is to ease the strain on the anus by softening the stools, reduce discomfort and bleeding while passing stool, and most importantly, heal the cut.
The permanent treatment of anal fissure can be achieved by stopping it’s reassurances after healing through the following methods:
Natural Remedies For Fissures:
Prevention of Constipation
Since this is the chief cause of hard and large stools that in turn could cause a tear in the anus. You could do so by staying hydrated. Drinking enough water can help soften the stool and make it easier to pass.
Taking diets rich in water content can also assist your water intake goal. Examples include, cabbage, broccoli, celery, cucumber, lettuce, strawberries, spinach, tomato, and watermelon.
Also, ensure an increased intake of high-fiber foods like beans, peas, whole grains, fruits, and vegetables.
Sitz Bath
Also known as Hip baths. This involves soaking yourself (bottom) in a warm bath for 10 to 20 mins severally per day. It helps to relax the muscles in the anus.
Lubricants
Use lubricants like petroleum jelly especially if you notice a cut.
Caring for Perianal Skin
It can be difficult to clean the fissured area due to pain, you gently use a hand shower to wash the area. Instead of toilet paper, use fragrance-free wet wipes to clean the anal region as it is less painful.
Medical Treatments For Permanent Cure:
Medications
Some medicines are recommended by the physician if the above methods don’t work, or if the anal fissures reoccur after a while. Some of them include:
- Laxatives
These are medications that help to relieve constipation. They add moisture to the stool, thereby softening it and enhancing bowel movement. It is the choice of treatment in children. - Fiber Supplements
These are the medicines that help to soften the stool and facilitate its expulsion from the anus. - Glyceryl Trinitrate
Also known as Nitroglycerin, is an ointment that can be applied twice daily to the anus. It helps to lower the pressure in the anus, thereby reducing the pain. It works by relaxing your internal anal muscles and increasing the blood supply to the anus.
The use of Glyceryl Trinitrate is a common practice as it heals the majority of the acute cases of anal fissures. However, before starting Glyceryl Nitrate treatment, you must consult your physician if you have pre-existing heart condition, pregnancy, anemia or allergy to any medicine - Botulinum Toxin Injections
This method is rather an emerging option in the treatment of anal fissures. It is usually resorted to if other medications prove to be futile.
Otherwise known as Botox, this refers to a neurotoxin injected into the anal sphincter to temporarily cause paralysis and reduce spasms. It has been recorded to successfully treat some conditions presenting with muscle spasms.
Though this procedure is relatively expensive, it has been shown to have a high frequency of healing rate but with the following side effects:
Weakness of the anal sphincters, leading to gas and fecal incontinence, pain and bleeding at the injection site[3].
Surgery
This becomes necessary when the non-surgical methods prove to be ineffective. It is often seen in chronic anal fissures.
Patients that are resistant to the above treatment options undergo surgery. It majorly involves a procedure called Lateral Internal Sphincterotomy (LIS).
This is a detailed and controlled division of the internal anal sphincter muscle which is an effective and commonly used method in the treatment of chronic and refractory anal fissures.
Here, a small cut is made at the internal anal sphincter. This reduces the tension in the anal muscles, decreases pain, and promotes fast healing of the fissure.
It has a success rate of over 90%. Hence, recurrence rates are exceedingly low especially when the procedure is properly performed by the surgeon.
Its disadvantage is that It has a high rate of fecal incontinence[4].
Fissurectomy
This is the process of cutting out the damaged tissue around the anal fissure. It can be carried out alone, with botulinum injections, or alongside Lateral Internal Sphincterectomy.
It is not generally recommended because of its likelihood to leave the patient with keyhole deformities.
If No Method Worked For You, Here Is The Final One To Cure Fissure Permanently!
Laser Treatment
Regarding the complications that arise from surgery, such as bleeding, pain, urinary retention, infection and sometimes recurrence, there is a great need to choose a more suitable and permanent method of treating anal fissures.
Laser treatment is the most advanced technique and the safest. Getting laser treatment may sound scary, but it actually isn’t.
Since the perianal skin is thin and sensitive, an innovative technique that is painless and leaves the patients more satisfied with results is a welcome development. It can be carried out with the use of a Carbon dioxide (CO2) laser.
The CO2 laser presents a fixed area of concentration and remarkable control during the surgery[5].
The treatment begins with the application of local anaesthesia. Then the base and the perimeters of the fissure are laser-beamed so as to remove fibrotic and granulation tissues.
Eight spots are made on the sphincter with the laser, passing through its full thickness in a continuous mode.
The infrared radiation then improves the blood flow to the area of the fissure. This influences the proper healing of the fissure.
Technically, the laser surgery, followed by proper healing process reduces the chances of recurrences, thus provide long term, and in many cases permanent cure from fissure.
Due to the pros laser technique offers, it is said to be the most efficient way to cure fissure permanently, safely and painlessly.
The advantages of laser treatment for anal fissure includes:
- Instant relief from pain and discomfort
- It is non-invasive, i.e., no stitches and no cuts
- The patients get discharged within 24 to 48 hours and can resume normal activities
- The procedure takes only 40-45 minutes
- Minimum post-surgery pain
- No scar surgery as there are no cuts or damages to the skin or any of the patient’s organs o
- Negligible recurrence rate
- No fecal or gas incontinence
In general, laser surgery is a minimally invasive procedure that reduces hospitalisation time. It decreases the postoperative pain, oedema, and discomfort, results in fewer complications, faster and more functional wound healing, and that leads to permanent recovery from fissure.
