Anal Fissure Treatment in Ahmedabad

What is an Anal Fissure?

An anal fissure (fissure-in-ano) is a small crack or tear in the thin, moist mucosa that lines the anal canal. Even though the tear itself is usually small, it can cause severe, sharp pain because the anal region has a rich supply of sensitive nerves. The pain is often accompanied by spasm of the internal anal sphincter, which further reduces blood supply to the area and delays healing.

Anal fissures can occur at any age, from young children to elderly adults. In most patients, the fissure develops at the back (posterior midline) of the anal canal. Fissures at other locations or multiple fissures may occasionally point to an underlying condition and should be evaluated by a surgeon.

Symptoms of Anal Fissure

• Sharp, burning or tearing pain during passing stools, often described as "passing glass"
• Pain that continues for several minutes to a few hours after passing stools
• A small amount of bright red bleeding on the stool, toilet paper or in the pan
• Spasm and tightness in the anal region
• Fear or avoidance of passing stools, which can worsen constipation and pain
• Itching or irritation around the anus
• A small skin tag near the fissure in long-standing cases (sentinel tag)

Acute vs Chronic Fissure

Anal fissures are broadly classified based on their duration and appearance:

Causes and Risk Factors

Most anal fissures are caused by trauma to the delicate lining of the anal canal. Common contributing factors include:

• Passage of hard, dry or bulky stools
• Chronic constipation and prolonged straining
• Episodes of chronic or severe diarrhoea
• Childbirth and delivery-related trauma
• A tight or spastic internal anal sphincter
• Low-fibre diet and inadequate water intake
• Certain underlying conditions in a small number of patients (evaluated by the surgeon)

When Should You See a Surgeon?

You should consider a surgical consultation if you experience:

• Sharp anal pain with every bowel movement
• Bright red bleeding that continues for more than a few days
• Symptoms that keep recurring despite dietary changes and medication
• A fissure that has not healed even after several weeks
• Any associated lump, swelling, discharge or fever

Diagnosis

An anal fissure is usually a clinical diagnosis. A gentle inspection of the anal region — carefully, because the area is often very tender — is generally sufficient to see the tear, particularly at the posterior midline. Additional examination such as proctoscopy may sometimes be deferred until symptoms improve or performed after applying a local anaesthetic. If the fissure is at an unusual location, does not heal, or if other symptoms are present, further evaluation may be advised.

Treatment Options

Treatment aims to relieve pain, break the cycle of spasm and reduced blood supply, and allow the tear to heal.

Conservative treatment

Most acute fissures respond well to non-surgical measures, which may include:

• High-fibre diet — fruits, vegetables, whole grains and adequate water to keep stools soft and bulky
• Stool softeners and fibre supplements — as prescribed by your doctor
• Warm sitz baths — sitting in warm water for 10–15 minutes, particularly after bowel movements, to relax the sphincter and improve comfort
• Topical medications — creams containing glyceryl trinitrate (GTN) or calcium channel blockers (CCB) such as diltiazem may be prescribed to relax the internal sphincter and promote healing
• Local anaesthetic ointments — may be used for symptomatic relief in selected cases
• Avoiding prolonged sitting and straining on the toilet

When surgery is considered

Surgery is usually considered for chronic fissures or those that do not heal with adequate conservative treatment. The commonly performed procedures include:

• Lateral Internal Sphincterotomy (LIS) — a small, controlled cut is made in a portion of the internal anal sphincter to reduce spasm, improve blood supply to the fissure and allow it to heal. It is often regarded as an effective option for chronic fissure in selected patients.
• Fissurectomy — removal of the edges of a chronic non-healing fissure, sometimes combined with other measures.
• Advancement flap or other procedures — considered in selected complex or recurrent cases.

Your surgeon will discuss which approach is most suitable, depending on the patient's condition, general health and preferences.

Recovery After Fissure Treatment

Recovery depends on the treatment used. With conservative treatment, symptoms often begin to improve within a few days, though complete healing may take a few weeks. After a procedure such as LIS, most patients experience noticeable relief in pain within a short period and can usually resume routine activity within a few days. Sitz baths, a high-fibre diet, stool softeners and simple pain relief are usually advised. Your surgeon will give you individualised guidance on diet, wound care and follow-up.

Prevention

Simple long-term habits can significantly reduce the risk of developing or repeating an anal fissure:

• Eat a high-fibre diet with plenty of fruits, vegetables and whole grains
• Drink adequate water throughout the day
• Stay physically active and avoid a prolonged sedentary routine
• Do not delay the urge to pass stools, and avoid straining
• Avoid prolonged sitting on the toilet
• Treat constipation and diarrhoea early with medical advice

Frequently Asked Questions