Prescriptions and medications vary depending on what the healthcare provider wants to prioritize in terms of treatment. They usually employ a two-pronged approach – treat constipation using lifestyle and diet changes while relieving the pain through pills or topical treatments – to resolve anal fissures.
In relieving constipation, there are two drugs that stand out: psyllium fiber and docusate sodium.
Psyllium fiber is more of a supplement than a drug and can be bought over the counter. Upon ingestion, the psyllium attaches to the stool and absorbs water for it, making the stool softer and easier to excrete. Consequently, this supplement must be taken along with plenty of water during the day; otherwise, it would worsen the constipation.
This drug can come in pill or powdered form. Either way, it brings the same side effects, like excessive gas, bloating, and stomach cramps, which can become uncomfortable especially for people who are working or are always outside their homes.
On the other hand, docusate sodium is an over-the-counter medication taken simultaneously with psyllium and makes the stool softer yet bulkier than normal. Because of this, frequent toilet breaks are lessened, and in turn, helps in the healing of anal fissures.
Docusate sodium can come in pills, tablets, or drops. In taking drops, a medication cup is needed to ensure that the patient will not exceed the recommended doses, as too much of docusate sodium can cause stomach pain, cramps, or worse, diarrhea. If any of these happens, the dosage must be decreased as per the doctor’s advice.
This supplement has a bitter taste so it is usually mixed with fruit juice or any flavored drink (except carbonated ones) to make it easier to take.
These two are proven to be effective in managing constipation. However, patients can develop dependence on these drugs even after the anal fissures are healed, so doctors still recommend following dietary and lifestyle changes, such as by increasing fiber intake (this includes eating fruits and vegetables) and exercising.
In relieving the pain, the patient’s first go-to drug would be ibuprofen. It reduces the swelling brought by inflammation. Oral doses of OTC drugs are considered safe, but are not recommended for those who have bleeding problems, those with allergies to non-steroidal anti-inflammatory drugs, and pregnant and lactating women. They are also off-limits to people who carry heavy loads or who drive regularly because of increased susceptibility to vision problems and stomach cramps.
Another pain reliever anal fissure patients can use is witch hazel extract or cream. This compound helps not only in pain relief but in wound healing – the ingredients found in it are known to reduce swelling and infection, and increase blood flow around the affected area. The cream must be applied after every bowel movement and up to six times a day. The only side effect associated with it is skin irritation, so it is safer to use than other OTC treatments for anal fissures.
Meanwhile, prescription medications specifically addressing pain caused by the tear and other complications are administered only if the pain is severe and unbearable. In this case, the first medication doctors give their patients is nitroglycerin. This prescription drug relaxes the anal sphincter, the muscle controlling the expansion and contraction of the anus – once tensed, the anal sphincter prevents blood from flowing around the infected area, which can further reduce the chances of healing.
Nitroglycerin is considered a more effective treatment than taking fiber and doing Sitz baths combined. However, its most common side effects, headaches and low blood pressure, can become a problem to some patients. Because of its potent ingredients, it is not recommended for pregnant and lactating women and those who have heart problems.
Before taking any medication, even over-the-counter ones, patients must first seek the advice of their respective healthcare providers.
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