New treatment methods aiming to relax anal muscles have been very successful in accomplishing healing and reversing the disability associated with anal tear. Non-healing of anal tear, persistent or recurrent, has been a real problem for many men causing intense pain and bleeding during defecation, worsening constipation. Pain after bowel movements sometimes can last up to several hours. Anal intercourse is one of the risk factors for non-healing anal tear, becoming a major headache for sexually active gay men adversely affecting quality of life.
Traditional ‘conservative’ management recommended by the doctors include high fiber diet to prevent constipation, warm baths (called Sitz baths) are highly effective as the initial treatment modalities. Sometimes hydrocortisone containing ointments, suppositories and foams are used to reduce the inflammation. Topical anesthetics and muscle relaxants are applied around the anus to reduce pain and promote muscle relaxation before a bowel movement or anal intercourse. Nitroglycerin or calcium channel blocker ointments (medications used to control blood pressure) are other forms of ointments used to relax the anal muscles and increase blood flow to the region, promoting healing. Many topical agents that require daily application are cumbersome and carry many adverse effects including incontinence, infections and debilitating headaches. Unfortunately, if these steps fail to achieve a complete healing, the problem becomes recurrent and nonhealing chronic leading to much serious problems such as anal scarring and stricture, and anal cancer.
A fissure fails to heal if there is too much scarring or persistent muscle spasms due to pain cutting off the blood flow to the area. In these cases, surgery is recommended. Surgery usually consists of making a cut to a small portion of the internal anal sphincter muscle to reduce pain and spasms and allow the fissure to heal. Cutting the muscle rarely results in the loss of ability to control bowel movements. Especially people engaging in anal intercourse are particularly at risk for incontinence when the muscle is cut surgically.
Botulinum toxin (Botox) injection to anus, into the anal sphincter temporarily paralyzes the anal sphincter muscle, relieves pain and promotes healing. Botox injection treatment has become an incredibly effective treatment choice for severe, persistent and recurrent anal fissures. Sometimes a small outpatient procedure to remove the crack and skin tags are done at the same time of Botox injection to expedite the healing process.
If you feel you have an anal fissure, it may be time to seek treatment. A comprehensive consultation at Soho Men’s Health will determine the condition and an effective treatment plan will be determined specific to your condition. To get started, please call our office today.