A fissure is nothing more than a cut at the anal verge or the anal opening. The muscle
beneath the fissure is very sensitive and is in a state of spasm due to irritation.
A cut in this area exposes the lining to the air and to the surrounding tissues and to
anything that comes out of the anus, and it’s irritated chronically and is very painful.
There are many medical measures that we can use to help patients heal without an operation.
Some of the simple things are keeping soap out of the anal area. This doesn’t just go
for the case where a person has an anal fissure, this should be always. You can keep the anal
area clean with just water. Should the fissure not heal with simple measures,
other things can be used. Stool softeners can be added so there’s no tearing in the
fissure. Topical hydrocortisone ointments or creams which are anti-inflammatories can
be applied to allow the fissure to heal, If this fails, there are other things that
can be used such as Diltiazem. Diltiazem is a medicine we use often to control blood pressure
but in the case of an anal fissure, it can be applied topically to relax the sphincter
muscle. The sphincter is what surrounds the anal area
and it is thought that a hypertonic sphincter or a sphincter that has got spasm causes much
of the pain and keeps the fissure from healing. So Diltiazem is applied by the patient three
times a day. Often this or the hydrocortisone will heal the fissure.
When all else has been tried, patients are offered two choices: either the patient can
live with the fissure (and some people choose to), or the patient can undergo a lateral