From the Guidelines
Treatment for an anal tear (anal fissure) should begin with non-operative management as the first-line treatment, including dietary and lifestyle changes with increased fiber and water intake, as recommended by the most recent guidelines 1. The goal of treatment is to reduce anal sphincter pressure, improve blood flow to the area, and promote healing.
- Conservative measures such as sitz baths, stool softeners, and adequate hydration can help alleviate symptoms.
- Topical treatments like nitroglycerin ointment or calcium channel blockers may be used to relax the anal sphincter and improve blood flow.
- Pain management can be achieved with over-the-counter pain relievers like acetaminophen or ibuprofen.
- If conservative treatments fail after 6-8 weeks, botulinum toxin injections or surgical procedures like lateral internal sphincterotomy may be considered. It is essential to note that the most recent guidelines from 2021 1 recommend against the use of manual dilatation and do not provide a recommendation for controlled anal dilatation due to limited evidence. Overall, the treatment approach should prioritize reducing morbidity, mortality, and improving quality of life, with a focus on non-operative management as the initial treatment strategy.
From the Research
Treatment Options for Anal Tear
The treatment for anal tear, also known as anal fissure, can be managed through various methods, including:
- Topical medications, such as lidocaine, diltiazem, glyceryl trinitrate, nifedipine, and minoxidil, to relieve pain and aid in healing 2, 3, 4
- Topical nifedipine and lidocaine ointment has been shown to be effective in relieving pain and aiding in the resolution of thrombosed hemorrhoids, reducing resting anal pressure, and healing chronic anal fissures 4
- Lidocaine 5% ointment has been used to treat anal fissures, with significant symptom improvement and no adverse effects reported 2
- Diltiazem has been shown to have the lowest recurrence rate and is effective in pain reduction, making it a recommended option for patients with heightened sensitivity to pain 3
Alternative Treatments
Other treatment options for anal tear include:
- Topical sucralfate, which has been shown to be safe and effective in promoting mucosal healing and providing analgesia during wound treatment 5
- Surgical therapy, which may be necessary for patients with persistent symptoms or those who do not respond to topical treatments 2, 3, 4
Key Findings
Key findings from the studies include:
- Nifedipine demonstrated the highest healing rate for anal fissures, followed by diltiazem and minoxidil 3
- Lidocaine exhibited the lowest healing rate for anal fissures, but was still effective in relieving pain and aiding in healing 2, 3
- Topical sucralfate was shown to be effective in promoting mucosal healing and providing analgesia during wound treatment, with no adverse events reported 5