Anal fissure

Wounds and tears in the anus can arise after a period of firm stool or heavy diarrhea. This causes, especially during and right after passing, heavy pains. Because it has become so painful, defecation is postponed, causing the stool to become even firmer. Generally, the wounds heal on their own within a few weeks. If after six weeks a wound was still not healed, we speak of a chronic fissure which needs to be treated. The fissures are usually localized at the front or the back of the anus, where the circulation is insufficient. Because of heavy pains, the sphincter is tightened subconsciously causing the circulation to lessen even more. Treatment focusses on improving circulation in this area.

Constipation or firm stool can be prevented by a diet rich in fiber, sufficient fluid intake and exercise. Sometimes these measures are insufficient and laxatives are required.

Treatment

ISDN/Diltiazem-ointment
This ointment is applied in the anus and facilitates a better blood circulation of the area. Additionally, the internal circular muscle relaxed, causing the blood supply to increase helping the wound to heal. At first, the ointment can cause headaches. If the headaches do not diminish or disappear after a week, Diltiazem-ointment can be prescribed. Both ointments should be applied for at least 3 months. A follow-up on the complaints happens after 6 weeks.

Botox injection
When ointment treatments do not have the aimed result, it is possible to inject Botox into the internal circular muscle. This lowers tension in the anus. Three to four days after injecting the Botox the internal circular muscle will relax and you will feel alleviation of pain. The effect of the Botox remains 3 to 6 months. During this period, you will keep you using the ointment until the wound is healed. In some cases, it is necessary to repeat the Botox treatment.