Stool softeners such as bran or psyllium seed preparations can help. Suppositories can be used if these measures do not work. Anesthetic ointment or solutions often help relieve the discomfort, but repeated use of pain killing or numbing ointments can cause irritation or inflammation around the anus. Warm sitz baths for 15 minutes after each bowel movement will give some relief. In extreme cases, the fissure must be repaired surgically.
Most anal fistulas start from small pouches called crypts.
An abscess may occur before or after a fistula develops. To diagnosis an anal fistula, a healthcare provider must exclude other diseases, such as intestinal inflammatory disorders or tuberculosis. The provider may need to look at the fistula by x-ray, insertion of a probe, or with a colonoscope. The only effective treatment is surgery to remove the fistula. If the anal fistula passes deep into the surrounding muscles, the patient may temporarily lose control of bowel movements after surgery.