Injection of botulinum toxin type A into the internal sphincter can lead to symptomatic relief and healing of some fissures. It is important to note that benign fissures are located in the posterior or anterior midline. The exposed white fibers of the internal sphincter muscle can be seen in the center of chronic fissures. Anterior fissures are seen more often in women. Often the pain is triggered by a bowel movement, can last for hours, and can be severe.
Some people have spasms of these muscles which lasts continuously through the day and for many weeks at a time.
Anal pain (proctalgia)
The alternative for patients who cannot tolerate that position is lying on the left lateral side with the right knee pulled toward the chest. Debridement of the fibrotic edges of a chronic fissure can stimulate healing when combined with fissurectomy. The relaxation of sphincter tone induced by diltiazem, nitroglycerin, and nifedipine can relieve the pain within a few days, but complete healing may take up to two months. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: This may mean adopting stress-relieving therapies.