A fissure is a tear in the lining of the anal canal. It is small, and it causes pain out of all proportion to its size.
The classic description is a sharp, tearing or cutting pain while passing stool, followed by a burning ache that can last for hours afterwards. There is often bright red blood on the paper or on the surface of the stool. Many patients begin avoiding going to the toilet because of the pain, which makes the constipation worse, which makes the fissure worse.
Why it does not heal on its own
This is the part patients are rarely told, and it explains everything about the treatment.
The pain of the tear causes the muscle ring around the anus to go into spasm. That spasm squeezes the small blood vessels supplying the area, reducing blood flow to exactly the spot that needs to heal. Less blood supply means slower healing, which means more pain, which means more spasm.
Breaking that cycle is the whole aim of treatment. Every effective treatment for a fissure works by relaxing the muscle spasm and keeping stool soft, whether that is done with an ointment or with a procedure. This is why simply taking painkillers does not work.
Acute and chronic
An acute fissure has been present for a few weeks. Most of these heal with medical treatment and do not need any procedure.
A chronic fissure has been present for longer, typically more than six to eight weeks, or keeps returning. The edges become thickened, a small skin tag often forms at the outer end, and healing with medication alone becomes much less likely.
Treatment without surgery
This should be tried first in almost every acute case, and it works for a large proportion of patients.
- Stool softeners and fibre, so that motions pass without tearing the healing tissue again
- Plenty of fluids, which is what makes the fibre work rather than making constipation worse
- Sitz baths, sitting in warm water for around ten minutes two or three times a day, which relaxes the muscle directly
- A muscle-relaxing ointment applied to the area, which improves blood flow and allows healing. Headache is a common side effect of some of these and usually settles
- Local anaesthetic ointment for pain relief while the above works
These need to be used properly and for the full course. Most treatment failures are actually incomplete treatment, with patients stopping after a few days once the worst pain settles.
When a procedure is needed
When the fissure is chronic, when it keeps coming back, or when a proper course of medical treatment has genuinely failed.
The aim of the procedure is the same as the ointment: to relieve the muscle spasm so that blood supply returns and the tear heals.
Laser treatment
Laser energy is used to release the spasm in a controlled, measured way and to treat the fissure edges, without the open wound left by older techniques.
The procedure takes around twenty to thirty minutes under spinal or short general anaesthesia, and it is usually day care with discharge the same evening.
Where a skin tag or thickened edge has formed, that is dealt with at the same time.
Continence, and why the technique matters
The muscle involved here is part of what controls continence, so how much of it is released, and how precisely, genuinely matters.
The traditional operation divided a portion of the internal sphincter with a blade. It works well and heals reliably, but a small proportion of patients report some degree of reduced control afterwards, most often difficulty holding wind.
A controlled laser release aims to achieve the same relaxation with less impact on the muscle. This is a reasonable thing to ask about directly before your procedure, particularly if you already have any difficulty with control, have had previous anal surgery, or have had children.
Recovery
Most patients notice the pain of the fissure itself improving within days, which is often a striking change after months of suffering.
Desk work is usually realistic within two to four days. Expect some discomfort for the first week, and continue stool softeners, fibre and sitz baths through that period.
Complete healing of the fissure takes a few weeks. Do not stop the softeners the moment you feel better, because a hard stool at week two can reopen it.
Risks
Delayed healing, particularly if constipation continues.
Recurrence, uncommon after an adequate procedure, more likely if bowel habits do not change.
Minor bleeding in the first days.
Some alteration in control, most often of wind, uncommon and the reason the extent of muscle release is kept controlled.
Infection, uncommon in this area despite what patients expect.
Preventing it coming back
A fissure is caused by something tearing the lining, and that is almost always a hard stool.
- Keep stool soft permanently, not just during treatment
- Adequate fibre and fluids together
- Do not delay or strain
- Do not spend long periods sitting on the toilet
- Treat any chronic constipation properly rather than with occasional laxatives
Frequently asked questions
Can a fissure heal without surgery?
Yes, and most acute fissures do, with stool softeners, fibre, sitz baths and a muscle-relaxing ointment used for the full course.
Why does it hurt so much for such a small tear?
Because the anal canal is densely supplied with nerve endings and because the muscle goes into spasm around it. The spasm is a large part of both the pain and the failure to heal.
How long should I try medicines before considering a procedure?
Generally six to eight weeks of proper, complete treatment. If it has not healed by then, or keeps returning, a procedure is reasonable.
Will treatment affect my control over motions?
The risk is small and relates to how much of the sphincter muscle is released. A controlled laser release is used with this specifically in mind. Raise it directly if you already have any difficulty with control.
How soon can I go back to work?
Two to four days for desk work in most cases.
Is the bleeding from a fissure dangerous?
The bleeding itself is usually minor. But bleeding should always be examined rather than assumed to be a fissure, since other causes including colorectal cancer can present the same way.
Can a fissure come back?
Yes, particularly if constipation and straining continue. This is why the diet and bowel habit advice is part of the treatment rather than an afterthought.
Consultation
Dr. Ripudaman Singh Lubana holds a Fellowship in Minimal Invasive Proctology from IMMAST, Mumbai, and has performed over 500 laser proctology procedures.
He consults at Doctor Square Hospital on VIP Road Zirakpur, Trinity Hospital in Zirakpur, Curasia Hospital in Dhakoli, and Adesh Medical College Hospital in Mohri, Ambala Cantt.
Call 8054173528 to arrange a consultation. If your fissure is recent, expect to be offered treatment without surgery first.
This page is for patient education. It is not a diagnosis or a treatment plan. Rectal bleeding always requires proper medical evaluation and should never be self-diagnosed. Every patient is examined and assessed individually, and surgery is advised only when it is clinically necessary.
