Anal fissure is painful, requires treatment plan
DEAR DR. ROACH: My husband has been diagnosed with a rectal fissure. It has been a couple of months, and it isn’t any better. He has been treated only with a stool softener. What do you suggest? — A.T.S.
ANSWER: Anal fissures are painful. Although a stool softener is one part of management for people who have constipation, additional treatments also are appropriate, including a sitz bath, which is just a few inches of warm water in a basin or tub that you soak your bottom in. When I was an intern, I wondered about the origin of the term “sitz bath.” My resident, Dr. Lynn Brown, told me that it’s because you “sitz” in them, and it turns out she was right: It’s from the German “sitzen,” meaning “to sit.”
Other treatments include increased fiber and a topical painkiller (there are many overthe-counter preparations in ointment form). These treatments help heal the fissure by relieving anal spasms caused by a painful bowel movement. I’m afraid your husband hasn’t had adequate treatment, leading to a vicious cycle of pain, spasm and nonhealing.
In addition to these treatments, fissures heal more quickly with a medication to increase blood flow to the area: Nitroglycerin is available as a prescription ointment, and nifedipine can be compounded for topical use by a pharmacist, with better healing and fewer side effects than nitroglycerin (but both of these work better than no treatment). If this isn’t effective after a month, he should be re-evaluated. There are other options available before considering surgical treatment. A gastroenterologist is a good resource if his primary doctor hasn’t been successful.
One other concern is that occasionally anal fissures are a sign of Crohn’s disease, a serious inflammatory bowel disease. People with recurrent, atypical (not in the midline) or nonhealing fissures should be evaluated for Crohn’s disease.
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