The use of specific creams and ointments is a primary clinical approach for healing anal fissures by addressing the underlying muscle spasms and providing symptomatic relief from pain and inflammation. An anal fissure is a small tear in the lining of the anal canal that often struggles to heal because of a cycle of involuntary muscle contractions and restricted blood flow. While some over-the-counter products focus on soothing the skin, more advanced prescribed treatments are designed to relax the internal anal sphincter muscle. By improving the local environment and restoring circulation to the site of the injury, these topical applications play a vital role in supporting the natural repair of the delicate mucosal tissue.
What We’ll Discuss in This Article
- The distinction between soothing barrier creams and medicated treatments
- How local anaesthetics manage acute pain during bowel movements
- The role of glyceryl trinitrate (GTN) in relaxing anal muscles
- Calcium channel blocker ointments and their impact on blood flow
- Safety considerations and common side effects of medicated topicals
- National clinical guidelines for the application and duration of treatment
Soothing Barrier Creams and Protective Ointments
Soothing barrier creams help manage the symptoms of an anal fissure by protecting the exposed tear from the chemical irritation of waste matter and moisture. These preparations often contain ingredients such as zinc oxide, petroleum jelly, or lanolin, which form a physical layer over the sensitive anoderm. By reducing the direct contact between the stool and the open wound, these creams can decrease the stinging sensation experienced during a bowel movement.
An anal fissure is a small tear in the lining of the anus that can cause sharp pain and bleeding, and it often improves within a few weeks if the area is kept clean and stools are kept soft. While barrier creams do not actively relax the anal muscles, they are an important part of conservative care, especially in the acute stage of a fissure. They help maintain skin integrity and prevent the area from becoming macerated or further irritated by frequent cleaning. These products are generally available over the counter and can be used safely alongside dietary modifications to support the early stages of tissue repair.
Local Anaesthetics for Immediate Pain Relief
Topical local anaesthetics, such as lidocaine, are used to provide rapid but temporary relief from the sharp, stinging pain that occurs when passing stool with a fissure. These medications work by temporarily blocking the pain signals from the dense network of sensory nerves located in the anal canal. Applying a small amount of anaesthetic cream shortly before using the toilet can make the act of evacuation less distressing for the patient.
The National Institute for Health and Care Excellence provides guidelines for the management of anal fissures, which include the use of topical anaesthetics for short-term pain relief. By reducing the initial peak of pain, these creams may also help to lessen the subsequent involuntary muscle spasm. However, local anaesthetics are intended for symptomatic relief rather than for healing the tear itself. They should be used for a limited duration to avoid potential skin sensitivities and should always be combined with treatments that address the underlying cause of the fissure, such as constipation management.
Glyceryl Trinitrate (GTN) for Muscle Relaxation
Glyceryl trinitrate (GTN) ointment is a specifically medicated treatment used in the United Kingdom to heal chronic anal fissures by relaxing the internal anal sphincter muscle and improving blood flow. When applied to the anal canal, GTN releases nitric oxide, which causes the smooth muscle fibres to relax. This reduction in muscle tension is essential for breaking the cycle of spasm and pain that prevents a fissure from knitting back together.
Lowering the resting pressure in the anal canal also improves circulation to the posterior midline, where most fissures are located. This area naturally has a limited blood supply, and improved perfusion is vital for delivering the oxygen and nutrients required for skin regeneration. Anal fissures that do not heal within a few weeks may be treated with glyceryl trinitrate (GTN) ointment to help the anal muscles relax and increase blood flow to the area. Because GTN is absorbed into the bloodstream, it can cause side effects such as headaches, so it is typically started under the guidance of a healthcare professional who will provide specific instructions on the correct dosage and frequency.
Calcium Channel Blocker Ointments
Calcium channel blockers, such as diltiazem or nifedipine, are alternative medicated ointments used to treat chronic anal fissures by reducing muscle tone with a lower risk of certain side effects compared to GTN. These medications work by blocking the movement of calcium into the muscle cells of the anal sphincter, which prevents the intense contractions that lead to spasms. Like GTN, their primary goal is to lower the internal pressure of the anal canal to facilitate better blood flow and promote tissue healing.
In many clinical settings, diltiazem ointment is considered if a patient is unable to tolerate GTN due to persistent headaches. While these preparations are highly effective at healing fissures, they are often produced as “special” formulations in the UK and require a prescription from a GP or specialist. Clinical studies have shown that consistent application of calcium channel blockers for six to eight weeks can lead to the resolution of many chronic fissures, provided that the patient also maintains soft stools and good local hygiene throughout the recovery period.
Comparison of Topical Treatment Types
The following table distinguishes the different functions of the primary topical aids used in fissure management.
| Treatment Type | Primary Function | Clinical Use Case | Availability |
| Barrier Cream | Physical protection and soothing | Acute irritation and prevention | Over the counter |
| Local Anaesthetic | Rapid numbing of sensory nerves | Managing sharp pain during pooing | Over the counter |
| Nitrates (GTN) | Muscle relaxant and blood flow booster | Chronic, non-healing fissures | Prescription only |
| Calcium Blockers | Muscle relaxant (low headache risk) | Chronic fissures; alternative to GTN | Prescription only |
Application Techniques and Safety Advice
The effectiveness of medicated fissure ointments depends heavily on the correct application technique and adherence to the prescribed duration of use. Unlike haemorrhoid creams, which are sometimes applied deep into the rectum, fissure treatments are usually applied to the skin just inside the anal opening, where the sphincter muscle is located. A small, pea-sized amount is typically sufficient, as excessive application can increase the absorption of the drug and lead to systemic side effects.
It is important to wash hands thoroughly before and after application. Patients are generally advised to continue the treatment for the full course, which is often six to eight weeks, even if the pain subsides earlier. Discontinuing the medication too soon can result in the muscle tension returning and the healing tissue re-tearing. If any unusual skin reactions, severe headaches, or dizziness occur during treatment, a medical review should be sought to discuss adjusting the dose or switching to an alternative preparation.
Conclusion
Creams and ointments for anal fissures range from simple protective barriers to potent muscle relaxants like GTN and diltiazem. While soothing agents manage daily discomfort, medicated ointments are essential for breaking the cycle of muscle spasm and restricted blood flow that characterises chronic fissures. Successful healing requires a combination of these topical treatments and a consistent commitment to maintaining soft stools. If you experience severe, sudden, or worsening symptoms, call 999 immediately.
Can I use haemorrhoid cream for an anal fissure?
Some haemorrhoid creams contain soothing agents, but they do not have the specific muscle-relaxing properties required to heal a chronic anal fissure.
Why does GTN ointment cause a headache?
GTN works by widening blood vessels; when it is absorbed into the system, it can also widen vessels in the head, leading to a temporary headache.
How long should I use diltiazem ointment?
Most clinical protocols recommend using the ointment twice daily for six to eight weeks to ensure the tissue has completely healed and stabilised.
Should I apply the cream inside or outside the anus?
Fissure ointments are usually applied just inside the anal opening (the anal canal) to reach the internal sphincter muscle effectively.
Can I get fissure healing cream without a prescription?
Soothing and anaesthetic creams are available over the counter, but muscle relaxants like GTN or diltiazem require a professional clinical assessment and prescription.
Will the cream work if I am still constipated?
Topical treatments are much less effective if hard stools continue to re-tear the tissue; managing your diet is a vital part of the treatment plan.
What should I do if the cream causes a rash?
You should stop using the product and consult a pharmacist or doctor, as you may have a sensitivity to one of the active ingredients or the cream base.
Authority Snapshot (E-E-A-T)
This medical education content provides accurate, evidence-based information regarding the use of topical treatments for anal fissures for the UK public. The material is developed by a professional medical writing team and reviewed by Dr. Stefan Petrov, a UK-trained physician with experience in general surgery, emergency care, and clinical education. All information provided is strictly aligned with the clinical standards and diagnostic pathways provided by the NHS and the National Institute for Health and Care Excellence (NICE).
