Suggest Treatment For Chronic Anal Fissure
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Detailed Answer:
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I appreciate your concern
If Anal Fissures get chronic then they are difficult to heal by diet and medication alone. Topical metronidazole, Posterisone forte (Phenol:0.3%w/w, Hydrocortisone:0.25%w/w) and local anesthetics like lidocaine are commonly used to facilitate healing and avoid infection. You are right Constipation further aggravates the matter and should be avoided by using ispaghula husk with cremaffin suspension. Both in combination lead to softer stool and easy evacuation.
A rectal exam would be required to gauge the severity of the fissure. A lateral internal sphincterotomy or a fissurectomy can be embarked upon in consult with a General surgeon or Proctologist. The pain of anal fissure due to the spasm of the sphincter is quite severe and is relieved adequately with a sphincterotomy done in time.
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Dr. M.S. Khalil