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What is a Fissure?

A fissure also called, an anal fissure is a minor cut or tear in the lining of the anus. It causes bleeding and mild pain. Like any normal cut, the body can heal the fissure on its own. However, if the cut is deep you need to seek the help of a doctor.

What causes a fissure to form?

When the anal canal stretches beyond its limit, it tears and causes a fissure to form. The stretching of the anal canal might be due to passing hard stools, diarrhoea, childbirth or anal sex.

Symptoms / when to consult your doctor

Anal fissures heal on their own within four to six weeks. But, if it does not heal even after 8 weeks or keeps recurring, it’s considered a chronic fissure.

You should see a doctor if you notice:

  • Blood in stools

  • Sharp pain when you pass stools

  • Itching or burning in the anal region

Why you should see a doctor?

Having fissures is quite common and can happen to people of all ages who have constipation, even infants. However, if your symptoms do not clear up even after 8 weeks, it’s important to consult a doctor.

Ignoring the symptoms can lead to:

  • Acute pain while passing stools

  • Anal Cancer

  • Serious infections

How is it diagnosed?

An anal fissure is diagnosed by a physical examination of the anal area. To find out the extent of the tear, the doctor might perform:

  • Anoscopy: An anoscope is a tabular device which is inserted into the anus to visualize the anus and rectum

  • Flexible sigmoidoscopy: A thin tube is inserted into the bottom portion of your colon. This procedure is can be undertaken for patients who have no risk of colon cancer

  • Colonoscopy: Insert a thin tube into the bottom portion of your colon. This procedure is can be undertaken for patients who have a risk of colon cancer

Dietary Restrictions

After the surgery, you must avoid constipation so that the cut can heal. To avoid constipation, one should follow a diet that consists of:

  • Fibre rich food

  • 10 -12 glasses of water

  • Simple, nutritious food

  • Avoid alcohol or coffee

Treatment for Fissures

Anal fissures can be treated based on how chronic the tear is. If the tear is a small one, it can heal with self-care like drinking plenty of water and intake of fibre rich food.

The doctor might also suggest medications like stool softeners, ointments to quicken the self-healing process.

However, if the fissure if a chronic one, you will have to undergo surgery to correct it.

Types of treatments:

SpecificsTraditional Open SurgeryLaser Surgery
Cuts and woundsYesNo
PainYesNo
RecurrencePossibleNo
Dietary RestrictionYesNo
Recovery Time1-2 Weeks24 hours
InvasiveYesNo
Blood lossMore blood loss during surgeryVery less
Chances of InfectionHighVery less

Traditional Procedure

The traditional procedure also called the Lateral Internal Sphincterotomy (LIS) is a procedure where the fissure is treated by cutting or stretching the muscles surrounding the anus.

Flow of the procedure:

  • Patient is given general anaesthesia for the procedure

  • An incision is made in the anal muscles to relieve pressure on the fissure.

  • The fissure heals quickly by itself

Recovery Time and Dietary Advice:

  • Hospital stay of 2-4 days or longer

  • Resume normal day routine after 6-10 weeks

  • Liquid diet initially followed by a fibre rich solid diet

Risks involved in the treatment:

Some of the risks of the procedure may be:

  • Excessive bleeding

  • Infection of the surgical wound

  • Anal fistula

  • Faecal incontinence

Laser Procedure

This procedure involves the use of laser technology. The fissure is sealed using the heat generated from the laser.

Flow of the procedure:

  • Patient is given general anaesthesia for the procedure

  • A laser is inserted into the natural opening of the anus and moved to the location of the fissure.

  • The laser is then switched on and the heat expelled is used to close the fissure

  • The surgery is complete within 30 mins without any cut and tear

Recovery Time and Dietary Advice:

  • 1 Day procedure with mild pain

  • Resume to normal routine from next day

  • Simple, bland, nutritious, fibre rich food

  • Visit the doctor 2-3 weeks after the surgery for a check-up

Risks involved in the treatment:

There are very less complications through this laser treatment. Some of the risks may be:

  • allergic or adverse reaction to anaesthesia or other drugs

  • bleeding

  • incontinence

  • infections

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