Fissure Treatment in Hyderabad

The anal canal is a short tube surrounded by muscle at the end of your rectum. The rectum is the bottom section of your colon (large intestine). An anal fissure (also called fissure-in-ano) is a small rip or tear in the lining of the anal canal. Fissures are common, but are often confused with other anal conditions, such as hemorrhoids.

Causes for Fissures

Fissures are usually caused by trauma to the inner lining of the anus from a bowel movement or other stretching of the anal canal. This can be due to a hard, dry bowel movement or loose, frequent bowel movements. Patients with a tight anal sphincter muscle are more likely to develop anal fissures. Less common causes of fissures include inflammatory bowel disease, anal infections, or tumors.

What are the Fissures Symptoms?

Anal fissures typically cause a sharp pain that starts with the passage of stool. This pain may last several minutes to a few hours. As a result, many patients may try not to have bowel movements to prevent pain.

  • Other symptoms include:
  • Bright red blood on the stool or toilet paper after a bowel movement
  • A small lump or skin tag on the skin near the anal fissure (more common when chronic)


Treatment includes: Chemical Sphincterotomy – use of 20 units of injection Botulinum toxin , which is injected in the internal sphincters in doctor’s office. The effect of this medicine starts after 48 hours and lasts for upto 3 months. It relaxes the internal Sphincter muscles and prevent it from reflexly contracting when the stools is passed, thereby giving rest to the fissure and escalates the healing process.

    Along with Chemical Sphincetrotomy, WASH regimen is advised as mentions below:-

  • A high-fiber diet and fiber supplements (25-35 grams of fiber/day) to make stools soft, formed, and bulky.
  • Drinking more water to help prevent hard stools and aid in healing. Around 10 to 12 glass of water at regular intervals is advisable.
  • Warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day (especially after bowel movements to soothe the area and help relax anal sphincter muscles). This is thought to help the healing process.
  • Medications, such as lidocaine gel for local application on the fissure at anal verge, gives lot of pain relief.
  • Medications such as diltiazam, nifedipine, or nitroglycerin ointment to relax the increases the local blood supply enhance the healing of fissure.


Chronic fissures are harder to treat and surgery may be the best option. The goal of surgery is to help the anal sphincter muscle relax which reduces pain and spasms, allowing the fissure to heal. Surgical options include surgical division of an inner part of the anal sphincter called as lateral internal Sphincterotomy (LIS).


Most patients can return to work and go back to daily activities within few days after surgery. High fiber diet and plenty of oral liquids are encouraged postoperatively as continued hard or loose bowel movements or spasm of the internal anal muscle can delay healing.

  • Injections are associated with healing of chronic anal fissures in 50% to 80% of patients.
  • Sphincterotomy is successful in more than 90% of patients.
  • Medications, such as lidocaine gel for local application on the fissure at anal verge, gives lot of pain relief.
  • Fissures often recurs [come back]. A fully healed fissure can come back after a hard bowel movement or trauma. Medical problems such as inflammatory bowel disease (Crohn’s disease), infections, or anal tumors can cause symptoms similar to anal fissures. If a fissure does not improve with treatment, it is important to be evaluated for other possible conditions.


Anal fissures do not increase the risk of colon cancer nor cause it.

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