I have chronic anal fissure(s), my doctor first prescribed me
Yes you can try it before the injection, or surgery
Hi and Welcome to 'Ask a Doctor' service.
I have read your question and here is my advice.
Anal fissures main cause is constipation or increased anal tone. While treatment of acute fissures, that is of less than 6 weeks is only using stool softener and local creams. That's what you have already exhausted.
Once the fissure is chronic, and not helped by the above as in your case then there are few options available, all focusing to release the tightness of the anal sphincter. The choice to be made is between surgery, or botox injection, or dilatation.
Botox injection is a newer technic, it quite effective and safe and is now recommended to be offered before surgery. However, it's expensive and with time the may not be very effective. But still, it should be offered before surgery...
Surgery (lateral sphincterotomy) is the gold standard for cases not relieved by other methods. It's very effective as it partially cut the tight band around the anal canal and hence reduces the tone. But may cause incontinence hence is the last option. So This will be the other option with you, but let it be the last option.
Anal dilatation (like what you have been told) is not favoured a lot these days and look out of fashion. but still, it has a role if the problem is not too much. It's easy and simple and has less complication. It may be quite effective if done gradually. There is a role for it, many times it helps and may save the operation or the botox Inj.
So it may not be the method of choice, but if the problem is not very advanced, you may give it a try. So if you are teased by the problem a lot, or you are an ideal type of person, then off course botox injection is better options otherwise dilatation can be tried first. It all depends on personal choice.
Make sure not to stop using more fibres, stool softeners, more fluids to relieve constipation along with these methods. You may use the creams with it for the pain as well as the pain medicines if needed.
Hope this helps you.
Please feel free to ask if you have any further questions or concerns.
I will be glad to answer further.
Dr Mahboob Ur Rahman