A doctor must diagnose the four anal disorders described here. Once the diagnosis is made, your treatment may or may not involve surgery, depending on the specific disorder. If surgery is necessary, your doctor will use whatever type of anesthesia is appropriate to help prevent you from feeling pain in this very sensitive area.
Anal fissure - For an acute fissure, your doctor may recommend that you follow the suggestions for relieving constipation that are described in the Prevention section above. He or she also may tell you to apply a medicated ointment to the fissure, and to soak the anal area in warm water for 10 to 15 minutes several times a day ("sitz bath"). For chronic fissures, surgery can correct the problem in more than 90% of cases.
Anal abscess - An anal abscess must be opened or lanced by a doctor to drain the pus. This procedure is called incision and drainage, or I&D. This usually can be done as an outpatient procedure, especially if you are young and generally healthy, and your abscess is close to the anal opening.
Anal fistula - Surgery to unroof the fistula track ("fistulotomy"), is the most effective therapy. Your doctor opens the infected canal and scrapes away any remnants of the old anal abscess. The wound is left open to heal from the bottom up. If the fistula is associated with Crohn's disease, treatment is directed toward the Crohn's disease with anti-inflammatory medications combined with an antibiotic.
Thrombosed external hemorrhoid - Usually this will slowly disappear on its own. The process can be hastened by taking a fiber supplement to soften the stool, as well as by taking frequent warm water soaks ("sitz baths"). If the hemorrhoid is unusually painful, the doctor may carry out a limited operation under local anesthesia to remove the clotted hemorrhoid.