Anal Fissure Treatment
About 50% of acute anal fissures heal without the need for surgery. Even deep chronic fissures can heal with conservative measures of dietary management (regular meals with increased fibre content) and use of stool bulking agents (such as Metamucil). Medical treatments such as GTN ointment can help heal chronic fissures and Botox (Botulinum toxin) injections have been shown to heal up to 80% of fissures and can be combined with removal of associated troublesome skin tags.
The surgical treatment of an anal fissure is reserved for failure of medical treatment. This is performed as a day procedure. The usual operation is sphincterotomy which is done under anaesthesia. This operation involves a small cut near the anal opening, with the division of the lowest part of the internal anal sphincter muscle. The fissure itself may not be removed. The spasm is relieved and the fissure is then able to heal. Any large or troublesome skin tag related to the fissure is removed.