Dharamveer Solanki Multispeciality Hospital

Anal Fissure Treatment - Dharamveer Solanki Multispeciality Hospital


Fissure surgery, also known as lateral internal sphincterotomy, is a procedure to treat anal fissures, which are small tears in the lining of the anal canal that cause pain, bleeding, and itching. This guide provides a detailed overview of fissure surgery for patients and the general public, covering topics from candidates for surgery to recovery.


An anal fissure is a small tear or crack in the lining of the anal canal, which can cause several symptoms, including:
  1. Pain during bowel movements: One of the most common symptoms of an anal fissure is severe pain during and immediately after bowel movements. The pain can be sharp, burning, or throbbing in nature.
  2. Bleeding: Bright red blood may be seen on toilet paper or in the toilet bowl after a bowel movement. The blood is typically a small amount and is separate from the stool.
  3. Anal itching: An anal fissure can cause itching or irritation around the anus, particularly after a bowel movement.
  4. Swelling: The area around the fissure may become swollen and tender to the touch.
  5. Skin tags: In some cases, a small skin tag may develop near the fissure, which can be mistaken for a hemorrhoid.
  6. Difficulty passing stool: The pain associated with an anal fissure can make it difficult to pass stool, leading to constipation in some individuals.
  7. Spasms in the anal sphincter: The pain from the fissure can cause the anal sphincter muscles to spasm, which can exacerbate the pain and make it difficult for the fissure to heal.
If you experience any of these symptoms, it’s essential to consult with a healthcare professional for a proper diagnosis and treatment.

If Anal Fissure Surgery is Right for You: Factors to Consider

Individuals with the following conditions may require fissure surgery:
  • Chronic anal fissures that have not healed with conservative treatments, such as medication, sitz baths, or dietary changes
  • Severe pain or discomfort associated with anal fissures
  • Recurrent bleeding from anal fissures
  • Fissures causing significant discomfort or impacting daily life

Types of Surgeries

There are two main types of fissure surgery:

Lateral Internal Sphincterotomy

Lateral internal sphincterotomy is a surgical procedure commonly used to treat chronic anal fissures. Anal fissures are small tears in the lining of the anal canal, which can cause significant pain and discomfort. The main goal of this procedure is to relieve pressure in the anal canal by making a small incision in the internal anal sphincter muscle, allowing the fissure to heal more effectively. During the procedure, the patient is placed under anesthesia, and the surgeon makes a small incision in the internal anal sphincter muscle on one side of the anal canal, usually opposite the fissure. This incision helps to reduce the resting pressure of the anal sphincter, allowing better blood flow to the area and promoting healing of the fissure. The success rate of lateral internal sphincterotomy is high, with most patients experiencing significant pain relief and healing of the fissure. However, there are potential risks, such as infection, bleeding, and, in rare cases, temporary or permanent incontinence.


Fissurectomy is another surgical procedure used to treat anal fissures that have not healed with conservative treatments, such as creams, warm baths, and dietary changes. This procedure involves the removal of the fissure tissue itself and the closure of the wound with sutures. During a fissurectomy, the patient is placed under anesthesia, and the surgeon carefully removes the fissure tissue along with any associated scar tissue or underlying infection. The wound is then closed with sutures, which helps to promote healing and alleviate pain. In some cases, a fissurectomy may be combined with a lateral internal sphincterotomy to further reduce pressure in the anal canal and promote healing. The recovery period for a fissurectomy may be slightly longer than that of a lateral internal sphincterotomy, and patients may experience some pain and discomfort during the healing process. However, most patients experience significant improvement in their symptoms after the procedure. As with any surgery, there are potential risks, including infection, bleeding, and the possibility of recurrence of the fissure.


Fissure surgery is usually performed under spinal anesthesia or local anesthesia with sedation, depending on the type of surgery and the patient’s medical history.

What to Expect During Consultation?

During the consultation, the surgeon will:
  • Discuss the patient’s medical history and symptoms
  • Perform a physical examination, including a digital rectal exam and anoscopy
  • Discuss the risks, benefits, and alternatives to fissure surgery
  • Provide pre-operative instructions, including dietary restrictions, medications to avoid, and bowel preparation if necessary

Fissure surgery typically takes 30 minutes to 1 hour, depending on the type and  severity of the fissure.

Patients undergoing fissure surgery may be discharged the same day or after an  overnight stay, depending on the type of surgery and the patient’s overall health.


Although fissure surgery is generally safe, complications can occur, such as:
  • Bleeding
  • Infection
  • Pain during bowel movements
  • Anal stenosis (narrowing of the anal opening)
  • Fecal incontinence (inability to control bowel movements)
  • Recurrence of anal fissures
  • Anesthesia-related complications

Pre-op Evaluation

Before surgery, patients will undergo a pre-operative evaluation, including:
  • Blood tests (e.g., complete blood count, coagulation profile, viral markers)
  • Imaging studies (e.g., ultrasound, CT scan) if necessary
  • Electrocardiogram (ECG) to assess heart function
  • Consultation with the anesthesiologist to discuss anesthesia options and risks

What Should I Expect During My Surgery Recovery?

After fissure surgery, patients can expect:
  • Pain and discomfort managed with medications prescribed by the surgeon
  • Gradual return to normal activities within 1-2 weeks, depending on the type of surgery
  • Temporary dietary modifications, such as a high-fiber diet and increased water intake
  • Sitz baths to promote healing and relieve discomfort
  • Follow-up appointments to monitor recovery and ensure proper healing

What Results Should I Expect After Surgery?

Fissure surgery is effective in relieving pain, itching, and bleeding associated with anal fissures. Most patients experience significant improvement in their symptoms after surgery. However, there is a risk of recurrence, which can be minimized by maintaining a high-fiber diet, drinking plenty of water, and avoiding straining during bowel movements.

Pain Concern

Pain following fissure surgery is expected but can be managed with medications prescribed by the surgeon. Most patients experience significant improvement in pain within a few days after the procedure. Over-the-counter pain relievers or prescription medications may be recommended to control pain and discomfort during the recovery period.


Fissure surgery is a common and effective treatment for painful or bleeding anal fissures that do not respond to conservative treatments. By understanding the process, risks, and recovery expectations, patients can make informed decisions about their treatment options and prepare for a successful surgery and recovery. Always consult with a qualified healthcare professional to discuss your specific situation and determine the best course of action for your condition.
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