What is the treatment for an anal fissure?
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In most cases the fissure will heal within a week or so, just like any other small cut or tear to the skin. Treatment aims to ease the pain and keep the faeces soft whilst the fissure heals.
EASING PAIN AND DISCOMFORT
- Warm baths are soothing, and may help the anus to relax which may ease the pain.
- A cream or ointment that contains an anaesthetic may help to ease the pain. You should use this only for short periods at a time (5-7 days). If you use it for longer, the anaesthetic may irritate or sensitise the skin around the anus. You can get one on prescription. You can also buy some of these products at pharmacies without a prescription.
- A cream or ointment that contains a steroid may be prescribed by a doctor if there is a lot of inflammation around the fissure. Steroids reduce inflammation, and may help to reduce any swelling around a fissure. This may help to any ease itch and pain. You should not use it for longer than one week at a time.
- Wash the anus carefully with water after you go to the toilet. Dry gently. Don't use soap whilst it is sore as it may irritate.
- Painkillers such as paracetamol may help to ease the pain (but avoid codeine - see below).
AVOIDING CONSTIPATION AND KEEPING FAECES SOFT
- Eat plenty of fibre by eating plenty of fruit, vegetables, cereals, wholemeal bread, etc.
- Have lots to drink. Adults should aim to drink at least two litres (10-12 cups) of fluid per day. You will pass much of the fluid as urine, but some is passed out in the gut and softens the faeces. Most sorts of drink will do, but alcoholic drinks can be dehydrating and may not be so good.
- Fibre supplements. If a high fibre diet is not helping, you can take bran, or other fibre supplements ('bulking agents') such as ispaghula, methylcellulose, or sterculia. You can buy these at pharmacies or get them on prescription. Methylcellulose also helps to soften faeces directly which makes them easier to pass.
- Toileting. Don't ignore the feeling of needing the toilet to pass faeces. Some people suppress this feeling and put off going to the toilet until later. This may result in bigger and harder faeces forming that are more difficult to pass later.
- Avoid painkillers that contain codeine such as co-codamol, as they are a common cause of constipation. Paracetamol is preferable to ease the discomfort of a fissure.
There are separate leaflets called 'Constipation in Adults' and 'Constipation in Children' that provide more details about fibre and constipation.
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