All anal fissure treatments take 6-12 weeks for full healing to take place. It is probably the most difficult place on the body to heal an open wound as daily bowel movements re-open and contaminate the area. Expecting faster healing than this time frame on an anal fissure is unreasonable. Avoid water sprayers on the anal area when suffering from open fissures as water pressure will re-open the wounds. Leave the area alone as much as possible to encourage healing. Keep your stools soft by using fiber or magnesium supplements. The above represent all the basics in treating an anal fissure successfully. For more information on basic treatments of anal fissures read this article.
The cause of an anal fissure is typically associated with hard stools and constipation. However, a tear in the anus can be caused by physical trauma such as scratching or vigorous wiping after bowel movements as well. It’s important to avoid ointments that thin or weaken this fragile tissue that allow easy tearing to take place. Frequent use of cortisone ointments thins the skin that can lead to anal fissures recurring again and again. Most anal ointments contain petrolatum, which also weakens skin tissues and can lead to easy tearing of the anus. Using a petrolatum-based ointment to try to heal an anal fissure will likely only lead to temporary healing. Many medical studies show using petrolatum-based OTC (over the counter) ointments just don’t work for a high percentage of anal fissure sufferers.
A key study that shows the effectiveness of a couple of treatments can be found here. Less than 10% of the participants in the study that were in the control group and only used over the counter products were healed after 8 weeks. About 50% of patients remained healed for 12 months after using a calcium channel blocker such as nifedipine. This is significantly better than using OTC products but still only gives a 50 -50 chance of being healed after 12 months. However Diltiazem Gel has show promising results (up to 88%) in this study.
You can search the internet and find many studies, such as this one here, showing the success rate of surgical lateral sphincterotomy to be over 90% and some show 99% depending on follow up times recorded. Most people seem to be happy with the results in these studies.
The facts definitely say that the treatment of anal fissures is difficult if not impossible going at it by yourself with most over the counter products. One of the few treatments that has proven by customer survey (not medical study) to be highly effective is the Pranicura Anal Fissure Treatment. In a 2017 survey of over 500 fissure sufferers, 90% said they had success. This number included people who dropped out before the recommended 8-12 week healing time so the actual success number may be higher. In addition, the Pranicura Treatment involves a simple change in dealing with your bottom daily for life and preventing future fissures is a key part of the program.
In summary, a doctor should be seen prior to starting any treatment. Diltiazem Gel applications are prescription only and show the most promise and likely should be tried first. If the fissure does not heal or side effects prevent use, then the Pranicura Treatment seems to be the next best solution and should be used for 8-12 weeks before a judgement of success or failure can be made. If the Pranicura treatment fails, surgery is usually considered the final option as the success rate is high but since some people have incontinence issues as a side effect of the surgery, it typically isn’t considered the first option.