At a glance
An anal fissure is a small cut in the anal canal up to the skin, and it is the most common cause of painful defecation, most times associated with bleeding. When treated appropriately in the initial stages, a fissure heals up to 75% with medicines, and the mainstay of treatment is keeping the stools soft. Where a fissure does not heal with conservative management, simple surgery relaxes the sphincters so the fissure can heal, and laser lateral sphincterotomy is done with a minimal incision, less pain and quicker recovery.
Anal Fissure & LASER Anal Fistula Surgery
What is Anal Fissure
Anal fissure is the most common cause for painful defecation (Opening bowels). Most times it is also associated with bleeding but not all the time. It is a small cut in the anal canal upto skin.
Pain while passing motion which can last upto few hours afterwards is the commonest complaint. This is usually associated with Constipation (Passing hard stool/pushing hard to open bowel). At times it is seen after episode of loose motion.
***Pain while passing stool is never caused by piles/haemorroids***
How is such Severe Pain Caused?
The easiest way to understand is if you sustain a small cut while cutting vegetables, pain will persist until the cut has healed. The pain gets aggravated whenever anything touches the wound, including clothes. Similarly, the pain gets stimulated when the stool passes through the anal canal touching the fissure.
What is the treatment of Anal Fissure?
When treated appropriately in the initial stages, fissure heals upto 75% with medicines. Longer the duration less likely it is to heal with creams and might need simple surgery to relax the sphincters so that fissure can heal.
- Main stay of treatment includes keeping stools soft. This is usually achieved by laxatives during the period of anal fissure but in the long run by eating more fruits and vegetables, drinking at-least three lts of water in a day and exercise.
- Local anesthetic cream applied 20 mins before passing the motion will help in relieving the pain.
- Second cream (2% Diltigesic) helps to relax the muscle which helps in the healing of the fissure. With this treatment usually 50-60% of fissures heal.
Next step should be injection into sphincters if patients are affordable. This will increase the chances of healing upto 75-80%. This is more so recommended in females as they have weak and small sphincters compared to men and more over they can also be damaged at the time of vaginal delivery. Injection causes only temporary relaxation of muscles (upto 6 months) so that fissure can heal.
Other wise in patients in whom fissure does not heal by conservative management simple surgery is required (LATERAL SPHNCTEROTOMY) . This will reduce the pain significantly within 24 hrs.
LASER in treatment of Anal Fissure
LASER has now revolutionised treatment of Anal Fissure. One can have LASER Lateral Sphincterotomy with minimal incision, Less pain and quicker recovery. Wound from the surgery is hardly visible
What is chronic Anal Fissure?
Any anal fissure that has not healed even after 6 weeks is called chronic anal fissure. Conservative measures are unlikely to work, and patients might need surgery most of the times.
What are the complications of Anal Fissure?
A small skin tag (sentinel skin tag) can develop in chronic fissures. Some patients may experience itching.
Fissure will never lead to cancer.
Questions patients ask
- What is an anal fissure?
- Anal fissure is the most common cause for painful defecation (opening bowels), most times associated with bleeding. It is a small cut in the anal canal up to the skin, and is usually associated with constipation (passing hard stool or pushing hard to open the bowel).
- Why is the pain so severe?
- As with a small cut on a fingertip, the pain persists until the cut has healed. The pain gets aggravated whenever anything touches the wound, so it is stimulated each time the stool passes through the anal canal and touches the fissure.
- How is an anal fissure treated?
- The mainstay of treatment is keeping the stools soft, by laxatives during the period of the fissure and in the long run by eating more fruits and vegetables, drinking at least three litres of water in a day and exercise. A local anaesthetic cream applied before passing motion relieves the pain, and a cream that relaxes the muscle helps the fissure heal. When treated appropriately in the initial stages, a fissure heals up to 75% with medicines.
- What happens if the fissure does not heal with medicines?
- The longer the duration, the less likely it is to heal with creams, and simple surgery may be needed to relax the sphincters so the fissure can heal. Laser lateral sphincterotomy is done with a minimal incision, less pain and quicker recovery, and the wound from the surgery is hardly visible.
- What is a chronic anal fissure?
- Any anal fissure that has not healed even after six weeks is called chronic. Conservative measures are unlikely to work, and patients might need surgery most of the times.
- Can an anal fissure lead to cancer?
- No. A fissure will never lead to cancer. A small skin tag (sentinel skin tag) can develop in chronic fissures, and some patients may experience itching.