About Anal Fissure

An anal fissure is a common and painful condition appearing as a small tear near the external anal opening.  Anal fissures can occur spontaneously or as a result of difficult bowel movements.  While anal fissures are almost always benign, they are usually tender and painful, especially during bowel evacuation.  About one million patients are diagnosed with fissures each year.

The tear in the anal lining exposes the underlying internal anal sphincter muscle, which then goes into spasm. This spasm aggravates the tear and causes severe pain. Sphincter spasm can occur after every bowel movement and last several minutes to several hours. This muscle spasm also prevents blood flow to the affected area, which limits healing and prolongs the vicious anal fissure cycle.

1. Surgical Sphincterotomy – A surgical division of all or part of the spastic internal anal sphincter.  This surgical procedure eliminates sphincter spasm and allows for healing of the fissure.  General anesthesia is usually required.  Some degree of postoperative incontinence for flatus or feces occurs in up to one-third of patients.

2. Chemical Sphincterotomy – In-home procedure in which patient uses a science-based pharmacological sphincter relaxant to relax the internal anal sphincter muscle.

Chemical sphincterotomy is a non-surgical process, which eliminates anal sphincter spasm using a pharmacological sphincter relaxant (Fissure Medication) delivered directly to the lining of the anus.  Chemical sphincterotomy has become increasingly popular as a first therapeutic option in patients with fissures.

Spasm of the internal anal sphincter can be relieved by using Fissure Medications such as calcium channel blockers (Nifedipine, Diltiazem) and topical nitrates (Nitroglycerine) whose action on the internal anal sphincter will cause it to relax and thereby eliminate the pain.*

Studies have shown that it is important to deliver Fissure Medications directly into the anal canal.  DoseRite has developed a unique and proprietary delivery system that ensures the Fissure Medication is applied directly to the anal lining, exactly one measured dose at a time. Topical application within the anal canal 2 to 3 times per day is the most effective way to keep the sphincter muscle relaxed and eliminate spasm and severe pain. Depending on the severity of the muscle spasm it may take anywhere from a day to several weeks for the sphincter muscle to relax.

Rubbing a pea-size amount of medication on the outside of the anal opening is simply not enough medication to relax the sphincter muscle, especially when applied outside of the anal canal. The risk of headaches with larger doses is significantly reduced if the patient can apply the medication internally without contacting the keratized skin of the fingers or outer anus. Another misconception in anal fissure treatment is that medications should be applied directly to the fissure like an antibiotic ointment. Since most Fissure Medications are sphincter muscle relaxants, applying these medications directly to the fissure does little to heal the tear and may actually cause more discomfort and irritation.