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The doctor will ask about your symptoms and medical history. A physical exam will be done. Anal fissures are generally visible, so diagnosis can be made with an anal exam. If it is not visible, but suspected, your doctor may need to do other tests as long as it is not too painful. These tests include:
Digital rectal exam—to feel for any lumps or abnormalities
Anoscopy—examination of the anal canal with a scope
Fissures usually occur in predictable locations around the anus. If there are multiple cuts, or a cut in an unusual location, the doctor may order additional tests to look for other conditions.
Treatment aims to heal the cut and prevent future anal problems. Most fissures heal on their own or with self-care. Fissures that are fairly new are easier to heal than ones that have persisted for longer than three months.
Fissures may heal by changing some of your daily habits. These include:
Warm sitz baths, especially after bowel movements, to help relieve pain and promote healing
Increasing dietary fiber intake
Increasing fluid intake
Using stool softeners or bulk laxatives
Your doctor may prescribe:
Topical medications to reduce pain and inflammation
Topical nitrates and calcium channel blockers to increase blood flow to the anus and promote healing
Injected botulinum toxin to relax tightened anal sphincter muscles
Surgery may be necessary for:
Fissures that do not heal with other treatment methods
Scar tissue or spasms in the anal sphincter muscles that may also delay healing
Surgical procedures include:
Lateral internal sphincterotomy—A tiny incision is made in the sphincter muscle fibers to prevent spasms that result in straining during a bowel movement.
Fissurectomy—Excision of the fissure
Anal advancement flap—Covering the fissure with tissue from another part of the body
Anal dilation—Rare procedure that widens and stretches the anal canal
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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.