Up to 70% of acute fissure patients recover with a change in diet and defecation habits and a hot water sitz bath in addition to medication. Dietary habits should be turned to more water and fibrous food consumption, and defecation is ensured to be carried out regularly and without excessive straining. Medication includes relaxing anal pomades and pomades containing local anesthetics. Acute anal fissure treatment can be performed with some local drugs that have been developed in recent years.
GTN ointment: Ointment containing 0.2% isosorbide dinitrate is applied 3 times a day around the anus and towards the base of the fissure. It is very successful in reducing pain, it also reduces anal spasm, but it does not have a healing effect.
Side effects such as headache, hypotension, and burning in the rectum may alienate the patient from the treatment, making it difficult for the patient to adapt. Diltiazem Pomat: 2% diltiazem ointment is applied by applying it around the anus 3 times a day for 2-8 weeks.
It has a pain-reducing effect like GTN Pomat. Its curative effect is quite limited, there is a high risk of recurrence even when curative.
Botox Injection: An injection into the internal sphincter muscles paralyzes these muscles. It is the most effective method after sphincterotomy. It is highly effective, including chronic anal fissure. It can be considered the gold standard in patients with poor general condition who cannot tolerate even local anaesthesia.
The application of this method is quite easy and patient compliance is very high. The most important disadvantage of this method, which has a success rate of up to 90%, is that it causes temporary incontinence throughout the treatment process. Another disadvantage is that it may require repeat doses.
Treatment of acute fissure is carried out in line with the main purpose of preventing recurrence and chronicity. Surgical treatment is applied in patients who do not heal for more than 15-20 days despite this treatment..