Anal Fissure: Causes, Symptoms & When You Need Surgery

An anal fissure is a small tear in the thin, moist tissue (mucosa) lining the anus. It commonly causes sharp, burning pain during and after bowel movements, and may be accompanied by bright red blood on toilet paper.

Acute Fissure

Recent tears (less than 6–8 weeks) often heal with medical management — stool softeners, topical ointments, warm sitz baths, and dietary changes.

Chronic Fissure

Long-standing fissures develop a skin tag (sentinel pile) and fail to heal due to persistent internal sphincter spasm. These usually require surgical or laser intervention.

• ●Sharp, severe pain during bowel movements
• ●Burning or stinging pain lasting minutes to hours after stools
• ●Bright red blood on toilet paper
• ●Visible crack or tear near the anus
• ●Small skin tag or lump near the fissure
• ●Itching and irritation in the anal area
• ●Fear of passing stools due to anticipated pain

• ●Passing hard or large stools (constipation)
• ●Chronic diarrhoea
• ●Straining during bowel movements
• ●Low-fibre diet
• ●Childbirth and pregnancy
• ●Inflammatory bowel disease (Crohn's disease)
• ●Anal intercourse
• ●Previous anal surgery

1. 1

   Medical Management

   Topical anaesthetic ointments, calcium channel blockers, stool softeners, and high-fibre diet for acute fissures.

2. 2

   Botulinum Toxin Injection

   Relaxes the internal sphincter to reduce spasm and promote healing.

3. 3

   Laser Sphincterotomy

   Precise laser release of sphincter spasm — minimal pain, faster recovery, no stitches.

4. 4

   Lateral Internal Sphincterotomy (LIS)

   Gold-standard surgical option for chronic fissures resistant to medical treatment.

Surgery is recommended when conservative treatment fails after 6–8 weeks, or when the fissure is chronic with a sentinel pile. Dr. Jadhav will assess your condition and recommend the least invasive effective option.

• ●High-fibre diet and 8–10 glasses of water daily
• ●Warm sitz baths 2–3 times daily for comfort
• ●Avoid straining during bowel movements
• ●Return to desk work in 2–3 days after laser treatment
• ●Attend all follow-up appointments