Anal fissure is a tear in the lining of the anal canal, which causes severe pain during and after defecation (bowel movement). The excruciating pain extends to the buttocks, thighs, and lower back, affecting an individual’s overall quality of life.
Treatment of fissures center on promoting a healthy bowel movement – no constipation and diarrhea. Constipation is addressed by increasing fiber and water in the diet. Diarrhea, on the other hand, can be prevented by treating the underlying condition or eliminating laxative use. The fissures usually resolve without needing surgery, however, the pain felt by patients can be so severe and debilitating that it emphasizes the need for pharmacologic treatment. The best prescription medications for anal fissures are as follows:
1. Pain management –
Pain in fissures are usually managed by taking OTC medications such as ibuprofen. However, severe pain may need stronger pain relievers such as:
•Lidocaine Jelly
It is a topical analgesic used to numb and treat inflammation of the injured anal wall. This should be applied to the affected area using gloves or cotton applicator. The maximum dose is 4 application within 24 hours. Common side effects include mild nausea, swelling, and stinging of affected area. Overdose can lead to serious adverse reactions such as slow/shallow breathing, mental changes (drowsiness, confusion), vision changes (double or blurred vision), irregular heartbeat, seizures, and fainting.
•Topical Nitroglycerin (Rectogesic 0.4% rectal ointment)
It contains glyceryl tinitrate which relaxes the muscles in the anorectal region thereby decreasing pressure and increasing blood flow in the affected area. It is applied for a maximum of 4 times a day and should only be used for 8 weeks. It should be avoided by pregnant and breastfeeding women, people with nitrate sensitivity, and those with cerebrovascular and heart problems.
•Xyloproct (5%/0.275% ointment)
It contains hydrocortisone acetate which reduces inflammation and lidocaine for pain relief. Use the special applicator and clean thoroughly after use. Do not apply more than 6g in a day. Likewise, do not use it for more than three weeks. Long-term use may produce corticosteroid effects such as immunosuppression and skin atrophy. It is also contraindicated to patients with existing heart ailments.
2. Management of Constipation –
Dry, hard stools are often managed by increasing fiber and water in the diet. Over-the-counter laxatives and fiber supplements can also be used to increase bulk. However, when all else fails, these are the best prescription medications for anal fissures which promote healthy bowel movement:
•Amitiza (lubiprostone) – is a prescription stool softener which is taken twice a day after meals. Side effects include headache, nausea, abdominal pain and vomiting.
•Linzess (linaclotide) – is prescribed only for adults (18 years and above). It works by softening stools and stimulating bowel movement. Usual dosage is one capsule a day, taken 30 minutes before meals. Do not break or chew the pill. It is contraindicated for those with blockage in the stomach or intestines.
•Duphalac (lactulose) – is a strong bulk-forming stool softener. Common side effects of lactulose include gas, upset stomach, diarrhea, and abdominal cramps. It comes in liquid or powder form (dissolved in 4 ounces of water). Use measuring devices to ensure accurate dosage.
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