Medical expert of the article
New publications
Anal fissure - Treatment
Last reviewed: 06.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Conservative treatment of anal fissure in the acute period primarily involves eliminating pain, sphincter spasm and normalizing stool. A diet with limited spicy and irritating foods is recommended. A cleansing enema of 1 liter of boiled water at room temperature is prescribed once a day.
The tip is thickly lubricated with Vaseline oil and inserted along the edge of the anus opposite to the fissure. During this period, independent bowel movements should be avoided due to the risk of exacerbation of pain and increased sphincter spasm. Laxatives are contraindicated as they may increase pain. After bowel cleansing, warm (38 °C) sitz baths with a weak solution of manganese for 10 minutes are recommended. The anus is dried with gauze or cotton wool, then a suppository of the following composition is inserted into the rectum: Extr. Belladonnae 0.015; Eroformi 0.1; Novocaini 0.12; But. cacao 1.7. Another bath should be taken before bedtime, and a suppository of the same composition is inserted rectally. The described course of treatment continues until the fissure is completely epithelialized (usually 4 to 6 weeks). Enemas are usually administered during the first 10 days from the onset of the disease, after which the stool is independent. To interrupt the pain syndrome and influence the reparative processes, such treatment methods as presacral novocaine blockades with 0.25% Vishnevsky solution, injections of alcohol-novocaine solutions, oil-anesthetic solution, hydrocortisone with novocaine under the fissure are also recommended. The most common injections are hydrocortisone under the fissure (25-50 mg in 3-4 ml of 0.5-1% novocaine solution).
When conservative treatment of anal fissure is ineffective, surgical intervention is resorted to, which consists of excision of the fissure and sphincterotomy. During the operation, existing hemorrhoids are also excised. In recent years, closed lateral subcutaneous sphincterotomy has been proposed for the treatment of uncomplicated anal fissure. The results show that after it, pain disappears faster and there are fewer relapses.
[