Anal Fissure Surgery in India

What Is Anal Fissure?

The anal fissure is a small tear in the lining of the anus. The anal fissure can cause pain, bleeding and/or itching.

Most fissures occur along the mid-line – the top or bottom – of the anus.
An anal fissure (AY-nul FISH-er) is a tear in the anus causing a painful linear ulcer at the margin of the anus. An anal fissure, also known as fissure-in-ano, may cause itching, pain or bleeding. Fissures can extend upward into the lower rectal mucosa; or extend downward causing a swollen skin tab or tag to develop at the anal verge, also known as a sentinel pile.

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Causes of Anal Fissure

The anal fissure usually develops when the anal tissue is damaged during a hard and dry bowel movement which tears the anal lining.

The anal fissure can also develop due to higher than normal pressure in the anal sphincters. Diarrhea and inflammation of the anorectal area can also cause an anal fissure.

Many women during childbirth develop an anal fissure. Other causes of the anal fissure are: digital insertion (during examination), foreign body insertion, or anal intercourse.

In some cases, the anal fissure may be caused by other health conditions, such as: Vitamin B-6 deficiency, abdominal pain, fever, weight loss, Crohn’s disease, inflammatory bowel disease (IBD) that causes bloody diarrhea, syphilis, a suppressed immune system, tuberculosis, HIV infection, anal cancer. A low fiber diet may also contribute to the development of a fissure.

Diagnosis in India

Diagnosis can be made by inspection. Closer inspection will frequently reveal a tag or sentinel pile. After gentle separation of the skin of the anal verge, the ulcer usually posterior can be seen. Frequently the fibers of the internal anal sphincter muscle can be seen at the base of this punched-out ulcer. A well-lubricated finger with lidocaine ointment and a small caliber anoscope will help delineate the extent of the lesion. A colonoscope or sigmoidoscope exam might be useful to rule out abscesses, colitis, and other causes of rectal bleeding.

A fissure should be distinguished from an ulcer caused by Crohn’s disease, leukemia, or malignant tumors, because it is not shaggy, large or indolent. Fissures are seldom multiple. A biopsy can help to determine the diagnosis.

How can a fissure be treated?

Often treating one’s constipation or diarrhea can cure a fissure. An acute fissure is typically managed with non-operative treatments and over 90% will heal without surgery. A high fiber diet, bulking agents (fiber supplements), stool softeners, and plenty of fluids help relieve constipation, promote soft bowel movements, and aide in the healing process. Increased dietary fiber may also help to improve diarrhea. Warm baths for 10-20 minutes several times each day are soothing and promote relaxation of the anal muscles, which can also help healing. Occasionally, special medications may be recommended. A chronic fissure may require additional treatment.

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Will the problem return?

Fissures can recur easily, and it is quite common for a healed fissure to recur after a hard bowel movement. Even after the pain and bleeding has disappeared one should continue to aim for good bowel habits and adhere to a high fiber diet or fiber supplement regimen. If the problem returns without an obvious cause, further assessment may be needed.

What can be done if a fissure doesn’t heal?

A fissure that fails to respond to treatment should be re-examined. Persistent hard or loose bowel movements, scarring, or spasm of the internal anal sphincter muscle all contribute to delayed healing. Other medical problems such as inflammatory bowel disease, infections, or anal growths (skin tumors) can cause fissure-like symptoms, and patients suffering from ­persistent anal pain should be examined to exclude these conditions.


Factors that increase your risk of developing an anal fissure include: 

    • Infancy. Many infants experience an anal fissure during their first year of life, although experts aren’t sure of the reason.


    • Old age. Older adults may develop an anal fissure partly because of slowed circulation, resulting in decreased blood flow to the rectal area.


    • Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing.


    • Childbirth. Anal fissures are more common in women after they give birth.


  • Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing.
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