Anal Fissures

What Are Anal Fissures?

Anal fissures are small cuts or tears in the skin lining the anal opening. They usually occur when hard or dry stools stretch the delicate tissue. The tear causes sharp, cutting pain during bowel movements and may lead to bleeding. This condition is very common across all age groups in India.

How Do Anal Fissures Happen?

Fissures occur when the anal canal is stretched or irritated beyond normal. 

Common reasons include hard stools, constipation, straining, prolonged diarrhoea, tight anal sphincter muscles, childbirth-related tears in women, and inflammatory bowel disease in a smaller group of patients. When the tear repeatedly opens during bowel movements, it becomes chronic.

Types of Anal Fissures

Acute fissures – Recent tears that usually heal within a few weeks with medicines and lifestyle changes
Chronic fissures – Long-standing tears lasting more than 6–8 weeks, often with exposed muscle fibres or a small skin tag, usually needing a procedure

Symptoms

• Sharp pain during and after passing stools
• Fresh red bleeding on stool or tissue
• Burning or itching around the anus
• Visible tear or skin tag in chronic cases
• Fear of passing stools due to pain

What Types of Treatments Are Available?

Treatment depends on whether the fissure is acute or chronic. Most acute fissures heal with non-surgical care.

Non-Surgical Treatments (First-Line Treatment)

1. High-fibre diet
2. Adequate water intake
3. Stool softeners to reduce strain
4. Warm sitz baths for 10–15 minutes
5. Topical anaesthetic gels for pain
6. Prescription ointments that relax the anal sphincter and improve healing
7. Avoiding straining and improving toilet habits
8. These methods are usually enough for acute fissures.

Surgical Treatments

Surgery is advised when the fissure becomes chronic, causes repeated pain, or does not respond to medicines. The following procedures are commonly used in India.

Laser Surgery (Laser Sphincterotomy / Laser Fissurectomy)

A preferred option because it is minimally invasive with quicker recovery and minimal bleeding.
How it’s done:
A focused laser beam is used to release the tight internal sphincter muscle or remove unhealthy fissure tissue.                                                                    The laser seals blood vessels while cutting, reducing bleeding and discomfort. Usually a day-care procedure.

Lateral Internal Sphincterotomy (LIS)

Considered the gold standard for chronic fissures with significant muscle tightness.
How it’s done:
A small cut is made near the anal opening to release a portion of the internal sphincter muscle, reducing spasm and allowing rapid healing.                  Performed as a short outpatient surgery.

Open Surgery (Fissurectomy)

Used when the fissure is fibrotic, has a large skin tag, or when previous treatments fail.
How it’s done:
The hardened fissure tissue is removed to start fresh healing. Sometimes combined with LIS if the muscle is tight.

Recovery

1. Pain improves within a few days
2. Acute fissures heal in 2–4 weeks with medicines
3. Chronic fissures treated with laser or LIS show improvement within 1–2 weeks
4. Light walking is encouraged
5. Avoid heavy lifting or strenuous activity for a short period
6. Mild bleeding may occur in the early phase

Aftercare

1. Warm sitz baths for comfort
2. Use prescribed ointments regularly
3. Keep stools soft
4. Avoid straining and long toilet sitting
5. Clean with lukewarm water and avoid harsh soaps
6. Seek medical review for severe pain, fever, heavy bleeding, or discharge

Diet Instructions

1. Include high-fibre foods such as fruits, vegetables, whole grains, and salads
2. Drink 2–2.5 L of water daily
3. Add natural stool-softening foods: banana, papaya, soaked raisins, warm water in the morning
4. Reduce spicy, oily, and processed foods common in Indian diets
5. Limit caffeine and alcohol if they cause constipation

Lifestyle Changes

1. Do not delay the urge to pass stools
2. Avoid long toilet sitting
3. Stay active with regular walking
4. Maintain a healthy weight
5. Manage stress to keep bowel habits regular
6. Treat constipation early to prevent recurrence