What is the treatment for an acute anal tear?

From the Guidelines

Treatment for an acute anal tear typically begins with conservative measures to reduce pain and promote healing, with non-operative management as the first-line treatment, as recommended by the most recent guidelines 1. The goal of treatment is to reduce pain, promote healing, and prevent recurrence.

Key Components of Treatment:

• Sitz baths (sitting in warm water) for 10-15 minutes several times daily, especially after bowel movements, to help relax the anal sphincter and increase blood flow to the area.
• Use of over-the-counter pain relievers like acetaminophen or ibuprofen as needed for discomfort.
• Stool softeners such as docusate sodium (100-300 mg daily) or fiber supplements like psyllium husk (one tablespoon in water 1-3 times daily) to help prevent constipation and reduce strain during bowel movements.
• Increased dietary fiber intake and drinking plenty of water (at least 8 glasses daily) to maintain soft stools. Some studies suggest the use of topical treatments like nitroglycerin ointment (0.2-0.4%) or prescription calcium channel blockers like diltiazem (2%) ointment, but the evidence is not strong enough to make a definitive recommendation 1.

Additional Considerations:

• Manual dilatation is not recommended due to the risk of further injury and poor healing outcomes 1.
• The use of antibiotics is generally not recommended for acute anal fissures, except in cases of potential reduced therapeutic compliance or poor genital hygiene, and even then, the evidence is weak 1.
• For persistent tears, a doctor might recommend botulinum toxin injections to temporarily relax the anal sphincter or, in severe cases, lateral internal sphincterotomy surgery. It's essential to note that most anal fissures heal within 4-6 weeks with proper care, but avoiding constipation is crucial for preventing recurrence.

Lifestyle Changes:

• Increasing fiber and water intake is strongly recommended to help prevent constipation and reduce strain during bowel movements 1.
• Avoiding constipation is crucial for preventing recurrence, and patients should be advised to maintain a high-fiber diet and adequate hydration.

From the Research

Treatment Options for Acute Anal Tear

• The treatment for an acute anal tear, also known as an anal fissure, typically involves a combination of conservative therapies and medications 2.
• Conservative therapies may include sitz baths, stool softeners, and analgesic ointments 3, 4.
• Medications such as topical metronidazole, glyceryl-trinitrate (GTN) ointment, and nifedipine with lidocaine ointment have been shown to be effective in treating anal fissures 2, 4, 5.
• A study found that topical metronidazole use in the treatment of acute anal fissure resulted in a statistically significant difference in pain reduction and healing rate compared to the control group 2.
• Another study found that GTN ointment was effective in treating children with anal fissure, with 83.9% of patients experiencing complete healing of the fissure 4.
• Nifedipine with lidocaine ointment has also been shown to be effective in treating chronic anal fissure, with 94.5% of patients experiencing healing after 6 weeks of therapy 5.

Comparison of Treatment Options

• A study comparing the use of Nitroglycerin ointment to a placebo found no significant difference in healing or pain relief 6.
• Another study comparing cold and hot sitz baths found no significant difference in pain relief, but the pain scores decreased gradually in the group using hot sitz baths 3.
• The choice of treatment may depend on the individual patient's needs and medical history, as well as the severity of the anal fissure.

Key Findings

• Topical metronidazole, GTN ointment, and nifedipine with lidocaine ointment have been shown to be effective in treating anal fissures 2, 4, 5.
• Conservative therapies such as sitz baths and stool softeners may also be beneficial in treating anal fissures 3, 4.
• Further research is needed to determine the most effective treatment options for acute anal tears and to compare the efficacy of different treatments 2, 6, 3, 4, 5.