Lifestyle changes
Changes to diet and lifestyle will help to encourage healing of a fissure. The main aim is to try and avoid constipation, so that stools are smaller and softer.

This can be achieved by eating a diet that is rich in fibre, including plenty of fruit, vegetables and wholegrain cereals such as brown rice, bread and pasta. You should also aim to drink enough water-based drinks so that your urine is no darker than pale yellow.

Taking a regular supplement of bulk-forming laxative (eg Fybogel) or a laxative that softens the stool (eg lactulose syrup) will help the healing process and prevent further tears.

Sitting in a warm bath after using the toilet may also relieve the spasm and bring some relief from the discomfort.

If your fissure has not healed despite these lifestyle changes, or if you are worried about it, you should see your doctor. If you have blood in your stool (rather than some spotting on toilet paper or in the bowel) or have recently experienced altered bowel habits or have been losing weight, another problem may be responsible for your symptoms and you should seek medical advice promptly.

Medicines
Creams or ointments that contain local anaesthetics (eg lidocaine) or steroids (eg hydrocortisone) can be useful in relieving the pain and inflammation, and consequently the spasm, of an anal fissure. Your doctor may prescribe these in conjunction with advice about avoiding constipation and, possibly, laxatives.

A number of new medical approaches to anal fissure have been introduced recently, although these are generally only prescribed by a hospital specialist. This is generally either a gastroenterologist or a colorectal surgeon.

Some of these treatments are based on medicines originally developed for treating heart conditions and high blood pressure, and are not officially approved (licensed) for treating anal fissure. They work by relaxing the muscle of the internal anal sphincter. This reduces the spasm and improves the blood flow to the anus. This helps the fissure heal. Ointments of glyceryl trinitrate and diltiazem, and ointment or tablets of nifedipine may be prescribed. Side-effects, particularly with glyceryl trinitrate, can include a headache.

An injection of botulinum toxin (Botox) is used by some specialists. It temporarily paralyses part of the sphincter, reducing spasm and so reduces the pressure in the anus and improves the blood flow.

Surgery
The aim of surgery is similar to that of medicines - to relieve the excessive pressure within the anal canal. This is done by cutting the internal anal sphincter in an operation called a lateral sphincterotomy, or by stretching it with an anal dilatation. These procedures are carried out in hospital under general anaesthetic. They are usually performed as a day case, without the need for an overnight stay. The treatment is generally effective at healing the fissure. However some degree of incontinence or an inability to control wind may result although this may improve with time.