Can Chronic Anal Fissures Heal with Proper Care?

Can chronic old anal fissures heal?

I have had an anal fissure for five years.
I feel like it's a small wound, but it keeps getting injured repeatedly.
Now, having a bowel movement is painful, but there is no bleeding.
I irrationally and unscientifically wonder if the wound is necrotic and won't heal.
However, I also have a recurring crack at the corner of my mouth that has been injured for a long time, and the wound is dry (it just doesn't hurt, so I ignore it).
After a few days of taking B vitamins, it healed on its own.
Is it possible that as long as I take proper care of the anal fissure, it still has a chance to heal?

University graduate but only has a junior high school IQ., 30~39 year old female. Ask Date: 2022/06/18

Dr. Zhang Shuhao reply Surgery

Acute anal fissures typically heal on their own; however, if the same area is repeatedly injured, it can lead to a chronic ulcer that is difficult to heal spontaneously.
In such cases, surgical intervention is required to excise the ulcer and slightly relax the anal sphincter, allowing the exposed new tissue to heal under reduced tension.

Reply Date: 2022/06/18

More Info

Chronic anal fissures can indeed heal with proper care, although the healing process may take time and requires a multifaceted approach. Anal fissures are small tears in the lining of the anus, often caused by trauma during bowel movements, particularly when passing hard stools. Chronic fissures, which persist for more than eight weeks, can become a source of significant discomfort and may lead to a cycle of pain and further injury.

The first step in managing chronic anal fissures is to ensure that bowel movements are soft and regular. This can be achieved through dietary modifications, such as increasing fiber intake (fruits, vegetables, whole grains) and staying well-hydrated. Fiber supplements, such as psyllium husk, can also be beneficial in achieving softer stools. Additionally, establishing a regular bowel routine can help minimize straining, which is a common cause of fissures.

Topical treatments are another important aspect of care. Over-the-counter creams containing hydrocortisone can reduce inflammation and promote healing. Prescription medications, such as nitroglycerin ointment or calcium channel blockers (like diltiazem), can help relax the anal sphincter, reducing pain and allowing the fissure to heal. These medications work by increasing blood flow to the area, which is crucial for healing.

In some cases, warm sitz baths can provide relief from pain and promote healing. Soaking in warm water for 10-15 minutes several times a day can help relax the anal muscles and improve blood circulation to the area. This practice can also soothe discomfort after bowel movements.

If conservative measures fail to provide relief, and the fissure remains chronic, surgical options may be considered. Lateral internal sphincterotomy is a common procedure that involves cutting a small portion of the anal sphincter muscle to relieve tension and promote healing. This surgery has a high success rate and can significantly reduce pain and discomfort.

Regarding your observation about the healing of other fissures, such as those at the corners of your mouth, it is possible for similar principles to apply. Nutritional support, including adequate intake of B vitamins, can play a role in skin health and healing. However, it is essential to address the underlying causes of these fissures, whether they are due to nutritional deficiencies, mechanical trauma, or other factors.

In summary, chronic anal fissures can heal with proper care, which includes dietary modifications, topical treatments, warm baths, and possibly surgical intervention if conservative measures are ineffective. It is crucial to consult with a healthcare provider for a tailored treatment plan, especially if the fissures persist or worsen. Regular follow-up can help monitor healing and adjust treatment as necessary, ensuring the best possible outcome for your condition.

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