Table of Contents
Treatment of anal fistula often varies, depending on whether Crohn's disease is present. (This is a chronic inflammation of the bowel, including the small and large intestine.) As noted, the physician will often perform tests to see if this disease is present in addition to an anal fissure. If it is, prolonged treatment with a variety of medications, including antibiotics, is most commonly undertaken. In most cases these medications will cure the infection and heal the fistula. If Crohn's disease is not present, it still may be worthwhile to try a course of antibiotics, but if these do not work, surgery is usually very effective.
An acute fissure is managed with non-operative treatments. In over 90% cases it will heal without surgery. Bowel habits are improved with a high fiber diet, bulking agents, stool softeners, and plenty of fluids. It is important to use these substances to avoid constipation and promote the passage of soft stools. Warm baths for 10-20 minutes several times each day should also help by soothing and promoting relaxation of the anal muscles. Occasionally, special medicated creams may be recommended in some cases of anal fissures.
A chronic fissure is a fissure lasting more than one month. Chronic fissures may require additional treatment. Depending on the appearance of the fissure, other medical problems such as inflammatory bowel disease or infections may be considered. In these cases testing may be recommended. A manometry test may be performed to determine if anal sphincter pressures are high; examination under anesthesia may be recommended to determine if a definite reason exists for lack of healing. Antibiotics in anal fissure treatment may be used for a short time. The doctor could also choose special medicated creams, especially if the fissure has become ulcerated or infected. It is important to keep the anus and area between the buttocks clean and dry during treatment. After bathing, the patient should gently pat dry with a soft towel, applying talcum powder. This is frequently recommended together with treatment. Sit baths may help relieve discomfort and promote healing. This involves soaking the anal area in warm (not hot) water for 15-20 minutes several times a day.