Fissures are tears or ulcers in the lining of the anal canal most often caused by trauma, the most common being a hard bowel movement,” says Edmund Leff, MD. Research points to anatomical problems that can contribute to chronic anal fissures, as opposed to isolated problems with the painful lesions. Increased pressure in the internal anal sphincter muscle and reduced blood flow to the area in which fissures occur may make you more prone to chronic problems. MORE: 6 Things Proctologists Want You To Know If you have fissures, you know these little sores can make your life—at least your sitting life—miserable. Take comfort in the fact that about 60% of anal fissures heal within a few weeks. In severe, chronic cases, surgery may be required, but it carries considerable risks, including the possibility of fecal incontinence if the anal sphincter is injured. But according to Leff, some fissures will respond to Botox injections, eliminating the need for surgery. And a number of nonsurgical remedies exist to help fissures heal. Here’s what our experts suggest for healing anal fissures.
Eliminate Hard Stools With Fiber And Fluid
The anal opening was never meant to accommodate large, hard stools. Generally a by-product of a Western diet lacking in fiber, rock-hard stools tug and tear at the anal canal, which can result in anal fissures and hemorrhoids. The solution? Adapt yourself to a diet high in fiber and fluids that produce soft bowel movements. Eating more fruit, vegetables, and whole grains, and drinking six to eight glasses of water a day are the best remedies and preventive measures you can use for anal fissures, says Leff. Once your stool is soft and pliable, your anal fissures should begin to heal on their own. (Here are 8 reasons to eat more fiber.)
Try The Petroleum Solution
Eating more fiber will soften your stool, but you can also protect your anal canal by lubricating it before each bowel movement. A dab of petroleum jelly inserted about a 1/2 inch into the rectum may help the stool pass without causing any further damage, says Leff.
Buff Yourself With Baby Powder
Following each shower or bowel movement, sprinkle on baby powder. This helps keep the area dry, which can help to reduce friction throughout the day. If the area is actively inflamed, skip this step, cautions Wal Baraza, MB, CHB, MRCS, because it can worsen anal itching. And steer clear of the powders with perfumes, which may be irritating, adds Judy Gerken, MN, FNP-BC. “People generally like to search for things that make them smell like a flower, but sometimes that can do more harm than good.” (See 10 more everyday, brilliant uses for baby powder.)
Watch The Wipes
Over-the-counter “wipes” are widely available, but many of them contain alcohol, which is the last thing you want to use if you have a fissure, says Gerken. MORE: 7 Things Your Poop Says About You
Avoid Diarrhea
It may seem odd that not only can hard, constipated stools worsen anal fissures—but so can diarrhea. Watery stools can soften the tissues around them, and they also contain acid that can burn the raw anal area. “If you tend toward loose stools and have a fissure, taking fiber supplements with a minimum of water can firm up your stools,” says Leff. Try these natural remedies to stop your diarrhea.
Don’t Scratch
Anal fissures may be itchy as well as painful, but using sharp fingernails on your tender anus can further abrade the skin and lead to a vicious cycle in terms of itching, says Baraza.
Shed Those Excess Pounds
The more weight you carry, the more likely you are to sweat. Perspiration in your anal area irritates the skin and slows the healing of fissures, says Leff. (Here’s 6 ways to get started when you have 50+ pounds to lose.)
Minimize Swelling With Hydrocortisone
Nonprescription topical creams containing hydrocortisone can help reduce the inflammation that often comes with anal itching, says Baraza.
Try A Vitamin Solution
Nonprescription ointments containing vitamins A and D, as well as aloe, may be particularly helpful for soothing pain and helping fissures heal.
Soak In A Hot Tub
Whether you fill your bathtub with hot water or slip into an outdoor hot tub, warm water helps relax the muscles of the anal sphincter, increases blood flow, and reduces much of the discomfort of fissures, says Leff. MORE: 5 Reasons You Need To Take A Bath Tonight
Steer Clear Of Certain Foods
While no food directly causes fissures, some foods may irritate the tissues of the anal canal. “Hot, spicy foods, as well as caffeine, are irritating,” says Leff. “Excess caffeine is probably the major cause of anal itching.”
Avoid Anal Entry
Anal intercourse can be a source of tears, says Gerken. The best treatment is prevention, so use adequate lubrication, she says.
Buy Yourself A Special Pillow
Alleviate the pain associated with the anal area by sitting on a soft or gel-filled pillow. “But avoid doughnut-shaped pillows,” cautions Gerken, “because they may restrict blood flow to the area.”
Don’t Read On The Toilet
“People shouldn’t be reading their morning paper or a novel while they’re sitting on the toilet,” says Gerken. “The seat has a constricting effect, and prolonged sitting causes engorgement of the blood vessels.”
Wipe Gently
Rough toilet paper and overzealous wiping slows healing of your fissures. Use only white, unscented, top-quality toilet paper. Perfumes and dyes can irritate the anus. You can soften toilet paper by moistening it with water before wiping. Make sure you dab after a bath, don’t wipe, says Baraza. Applying petroleum jelly after a bath can help soothe itching, too.
Substitute Facial Tissue
The very best toilet paper isn’t a toilet paper at all. Facial tissues coated with moisturizing lotion offer the least amount of friction.
Use A Bidet, If You Have One
There are portable bidets available, which divert water from your bathroom faucet to underneath your toilet seat. A narrow stream of water, aimed right where you need it most, does all your “wiping” for you. There’s no need for toilet paper, except for one or two sheets to pat yourself dry. This is the best way to cleanse the area, says Leff.
When To Call A Doctor
Fissures don’t require special medical attention, unless they persist. The real caution with fissures is not to put them off forever—an ulcer that doesn’t heal may be cancer. If you have fissures that don’t heal within 4 to 8 weeks, get them evaluated. A sore that will not heal is one of the 7 classic warning signs of cancer. In addition, if you notice a mucus discharge from your anus, have it checked out by a doctor. The possibility of perirectal/perianal abscess formation should be considered if there’s any persistent pain or discharge, says Gerken. Abscesses can be very serious in that area.
Panel Of Advisors
Wal Baraza, MBCHB, MRCS, is a specialist registrar in general surgery at Sheffield Teaching Hospitals in Sheffield, UK. Judy Gerken, MN, FNP-BC, is a nurse practitioner and the HIV program coordinator at the VA Long Beach Health Care System in Long Beach, California. Edmund Leff, MD, is a colon and rectal surgeon in Phoenix and Scottsdale, Arizona.
