How long to use the treatment
For a case that is being treated for the first time, four to eight weeks is generally sufficient.
For chronic conditions, treatments can take up to four months.
In acute or repeat cases after a long period of rest, symptoms usually resolve with a treatment of one to three weeks.
Is it common for symptoms to recur?
Yes, but they tend to fade over the years. This is especially true when there is proper management of diet and constipation.
What to do if bleeding occurs after treatment
Often a person who has been successfully treated for an anal fissure will begin to experience anal bleeding that was not previously present. In this case, the pain that is typical of anal fissure is generally absent or mild. The release of pressure in the anal canal allows the hemorrhoidal varices, if they were present in the first place, to swell.
As a result, hemorrhoids can emerge (see hemorrhoid grades) or begin to bleed due to trauma.
Bleeding can be abundant in this case and sometimes even drip into the toilet.
What to do in this case
Simply proceed with one or more hemorrhoidal ligations. Ligation, which is often uncomfortable in the presence of a fissure and therefore of sphincter hypertonia, then becomes much easier and more comfortable.
If a person has been treated for a fissure and returns for hemorrhoidal bleeding, it is important to resume the treatment with nifedipine or other drugs so that the ligation procedure does not cause contraction of the sphincter.
While waiting for a ligature, it can be helpful to apply Ihle’s Paste into the anal canal. This often helps reduce bleeding.