You Ask, They Answer
Q
: What kind of tests are done for patients with anal fissures and how are they diagnosed?
A
: The doctor will ask you about your symptoms, followed by examining your back passage. You’ ll lie on your side while the doctor performs gentle parting of your buttock cheeks to inspect the anus. The doctor may gently insert a lubricated gloved finger to open your anus, noticing any tenderness or muscle spasms. This is called a digital rectal exam.
Q
: What medications are used to treat anal fissures and when is surgery needed?
A
: If the simple treatments mentioned above don’ t work, medication would be the next option, which include:
Nitroglycerin ointment: Nitroglycerin is a medicine that makes your blood vessels expand. Applied as a cream around the anus, it restores blood flow and helps your anal muscles relax. However, some patients may experience side effects after using this ointment, such as headaches which may be intolerable. Calcium channel blockers: These are usually diltiazem or nifedipine and are an alternative to nitroglycerine ointment but without the side effect of headaches. Botox solution: Botox can be administered into your anal muscles to help relax them as it’ s a powerful muscle relaxant. Its effects last for about three months, giving your fissure sufficient time to heal. Bulk Laxatives: Not everyone with constipation requires medication for it, but they can help if you have very hard poop that causes additional stress on your anal fissures. Bulk laxatives, such as Metamucil ®( psyllium), draw fluid into your gut to help soften your poop. Surgery: If your anal fissure won’ t heal with medication, you might need to consider undergoing a minor surgical procedure. Medications have mixed results for chronic anal fissures, while surgery comes with an over 90 percent success rate in healing them.
The procedure is called an internal sphincterotomy and is usually performed under anaesthesia. The surgeon will make a small cut into your anal muscle to release tension permanently. After recovering from anaesthesia, you can be discharged home on the same day.
Q
: Apart from medication or surgery, are there other things one can do to help heal an anal fissure?
A
: Most simple anal fissures will heal on their own, but you can help the process along with a few self-care tips:
• To make pooping more comfortable and easier, consider a stool softener. Use a step stool to elevate your feet while sitting on the toilet, which helps position your hips in a squatting position.
• Clean your anus gently with soft paper or alcoholfree wet wipes. Consider using a bidet or shower after pooping.
• Take a sitz bath for at least 10-15 minutes, two to three times a day. This is a warm-water bath that you sit in to soak your anus. It can relieve your symptoms and help relax your anal muscles.
Q
: Should I modify my diet while living with an anal fissure?
A
: It might help to drink more water, eat more fresh fruits and vegetables, and avoid spicy foods and nuts while you have symptoms.
Dr Ang Chin Wee
Dr Ang Chin Wee is a consultant general and colorectal surgeon at Mahkota Medical Centre in Malaysia.
20 ISSUE 1 | 2025 GlobalHealthAsiaPacific. com