Fissure FAQs

Following are the common questions about Fissure:

1. What is a fissure?
2. What are the different types of anal fissure?
3. What are the causes of anal fissures?
4. What are the symptoms of anal fissure?
5. Who treats anal fissure?
6. What diagnostic tests are done before anal fissure treatment?
7. How is anal fissure treated?
8. Why is laser surgery considered the best treatment for anal fissure?
9. What is fissure surgery (sphincterotomy)?
10. Is treatment for anal fissure necessary?
11. What is the best surgical treatment for anal fissure?
12. What is the cost of anal fissure surgery?
13. What factors affect the cost of anal fissure surgery?
14. What are the signs that anal fissure is healing?
15. When to see a doctor for anal fissure?

Q. What is a fissure?

A. A fissure, also known as anal fissure, is a small cut or tear in the thin, moist tissue (mucosa) that develops in the lining of the anal opening. It may lead to pain, bleeding during bowel movements, and discomfort while walking, standing, or sitting.

20-35 percent of India’s population are reported to have anal fissures. Anal fissure is highly observed in the urban (18%) and suburban (12%) populations. It equally affects both men and women and most often occurs in adults aged 15-40.

However, the prevalence of fissure was higher in men (19.41%) than women (14.14%) and higher in people aged between 18-40 years than 41-60 years.

Q. What are the different types of anal fissure?

A. Mainly, there are two different types of anal fissure, such as:

• Acute fissure:- This type of fissure is the most common and usually clears up within six weeks. In most cases, acute mild cases of fissure don't require medical interventions.
• Chronic fissure:- When a fissure lasts more than six months, it's called a chronic fissure. This requires proper medical intervention. The fissure may not heal without treatment and lead to several other serious complications.

Q. What are the causes of anal fissures?

A. Trauma in the anal canal is the most common cause of anal fissure. It occurs due to constipation or anal sex. Regardless of the reason, if you experience the symptoms or are diagnosed with the disease, you should consult a specialist doctor as soon as possible.

Q. What are the symptoms of anal fissure?

A. The following are the most common symptoms of anal fissure:-

• Anal bleeding
• Rectal pain
• Itchiness
• Cracked skin
• Small lump or skin tag

Consult a proctologist as soon as you start noticing any of these symptoms to avoid further complications. Then, the doctor can treat the disease with effective treatment options.

Q. Who treats anal fissure?

A. A proctologist, gastroenterologist, or colon or rectal surgeon treats anal fissure. A proctologist specializes in diagnosing and treating the lower gastrointestinal tract (colon, rectum, and anus), and a gastroenterologist specializes in digestive diseases.

Q. What diagnostic tests are done before anal fissure treatment?

A. A proctologist may recommend specific diagnostic tests to examine the anal tissue before moving ahead with the treatment process.

• Anoscopy:- This is done to examine the anus, anal canal, and lower rectum.
• Sigmoidoscopy:- The doctor checks the lower part of the intestine with the help of sigmoidoscopy.
• Biopsy:- This test helps the doctor in examining the rectal tissue.
• Colonoscopy:- The doctor examines the colon region by performing this test.

The doctor chooses the best-suited treatment based on the test findings.

Q. How is anal fissure treated?

A. An anal fissure is treated in several ways. However, the type of treatment your doctor chooses depends on several factors such as type, cause, symptoms, and severity of anal fissure. For example, mild cases of anal fissure can be treated by addressing the causes. In such as case, the doctor may recommend dietary and lifestyle changes and suitable non-surgical treatment options for your problem.

The aim of the treatment for mild cases of anal fissure is to lower the pressure exerted on the anal canal by passing soft stools and improve the symptoms like pain, bleeding, and discomfort.

The doctor may advise the following as the primary treatment options for anal fissure:-

• Prevent constipation by drinking an adequate amount of water, fluids and taking stool softeners.
• The doctor may ask you to avoid caffeine-based beverages and products that cause dehydration.
• Use sitz bath or warm water for 10-20 minutes, 3-5 times a day. It helps in relaxing the anal muscle and reduces pain and discomfort.
• Gently clean the anorectal area daily and avoid sitting on the toilet for an extended time.
• Use a prescribed cream or ointment for the anal fissure to help lubricate the anorectal area.

If none of these help you with an anal fissure, the doctor may again diagnose and recommends other treatment options such as surgery. However, non-surgical treatments don't work with chronic and severe anal fissures. In such a case, the doctor uses surgical treatment.

Anal fissure surgery is done in two ways: open surgery and laser surgery. Open surgery is a conventional way of treating anal fissures. However, laser surgery is a modern and advanced treatment that can cure anal fissures for once and all.

Before anal fissure laser surgery, you should keep in mind to choose an experienced and reliable proctologist.

Q. Why is laser surgery considered the best treatment for anal fissure?

A. Laser surgery is an advanced treatment method that can cure anal fissures once and for all. The following are the benefits of choosing laser surgery to treat anal fissures:-

• Involves no incisions or stitches
• Inflicts no pain or bleeding
• Minimal risk of recurrence
• Same-day surgery and discharge
• It gets completed in around 30-60 minutes
• Negligible risk of complications during or after the surgery
• Considered the best and permanent treatment of anal fissure

Apart from all the above, the recovery after anal fissure laser surgery is quick and comfortable. You can start your daily routine within 2-3 days of your surgery. Complete recovery takes around 5-10 weeks.

Q. What is fissure surgery (sphincterotomy)?

A. Fissure surgery, also called sphincterotomy or internal sphincterotomy, is used to cut the anal sphincter. The anal sphincter is a group of muscles connected to the rectum at the end of the digestive tract, through which bowel movements are passed.

Q. Is treatment for anal fissure necessary?

A. Yes, treatment for anal fissure is necessary. Acute or mild fissures can be treated/healed with home remedies, dietary changes, and lifestyle modifications such as a fiber-rich diet, stool softeners, fiber supplements, or daily exercise.

However, chronic, severe, or long-term anal fissure is not likely to heal without surgery. If a fissure lasts more than several weeks, it needs surgical treatment. Unfortunately, many people ignore fissure symptoms or take the disease seriously, thinking it would heal independently.

But it's essential to notice that if the fissure is not acknowledged medically and timely, it's very likely to recur. Not only this, if the anal fissure is left untreated for an extended period, it can also potentially lead to severe complications such as:

• Rectal prolapse
• Anal cancer
• Bleeding in stool

If you experience fissure symptoms or are suffering from this disease, you should immediately consult with an experienced proctologist and get your condition diagnosed and treated effectively.

Q. What is the best surgical treatment for anal fissure?

A. Laser surgery is considered the best surgical treatment for anal fissure. It's an advanced daycare procedure that involves minimal to almost no pain or bleeding during the entire treatment process.

Q. What is the cost of anal fissure surgery?

A. The average cost of anal fissure surgery ranges between Rs. 40,000- Rs 60,000. However, this is not the final cost of the procedure. Several factors affect the overall cost of fissure surgery.

Q. What factors affect the cost of anal fissure surgery?

A. Many factors significantly affect the cost of anal fissure surgery. This mainly includes the following:-

• Type of anal fissure
• Causes and severity of anal fissure
• The fee of the doctor
• Diagnostic tests are done before the surgery
• Type of surgery
• Location and type of hospital
• Hospitalization
• Medications post-procedure
• Follow-up visits with the doctor

We suggest you directly call the clinic/hospital or healthcare service provider you have chosen to undergo anal fissure surgery and discuss the approximate cost of your surgical treatment.

Q. What are the signs that anal fissure is healing?

A. Feeling less pain during bowel movements is a sign that anal fissure is healing. The pain will dissipate entirely, and you will be able to walk, stand, and sit without any discomfort.

Q. When to see a doctor for anal fissure?

A. If you notice blood in stools and itching in the anus with a malodorous discharge, you should consult a doctor and get your symptoms checked. Also, if a skin tag starts to form near the anal region, you should visit a specialist doctor immediately. Ignoring the signs of anal fissure or delaying the treatment can lead to severe complications.