What is the first-line treatment for anal fissure?

The first-line treatment for anal fissures is aimed at addressing both the symptoms and the underlying causes to promote healing. Stool softeners help reduce straining during bowel movements, which can exacerbate fissures, while topical nitroglycerin serves to relax the internal anal sphincter, decreasing anal pressure, thus promoting healing of the fissure.

Topical nitroglycerin is effective because it enhances blood flow to the area, which can help heal the fissure and alleviate pain. The combination of stool softeners to prevent hard stools and topical nitroglycerin for sphincter relaxation addresses the key factors contributing to the development of fissures.

While other treatments may be considered for more severe cases or if initial treatments fail, they are not the first line. For instance, partial sphincterotomy is typically reserved for chronic fissures or those that do not respond to conservative management. Topical corticosteroids may help with inflammation but do not specifically address the underlying problem of sphincter pressure. Oral analgesics can provide pain relief, but they do not contribute to the healing process of the fissure itself.