Anal Fissure Surgery

Anal fissures lead to pain and bleeding during bowel movements. It could also lead to spasms in the muscle ring at the end of the anus, known as an anal sphincter.
An anal fissure is commonly seen in young infants but could occur at any age. Most anal fissures can be treated by medications and self-care. However, some anal fissures may need surgical treatment.

Types: Anal fissures are of the following two types:

Know More About Surgery

The different symptoms associated with anal fissure include:

  • Difficulty in passing stools
  • Pain during bowel movements
  • Blood in stools
  • Tears in the anal canal
  • Painful urination
  • Burning and itching sensation in the anal region
  • Foul-smelling discharge from the anus

 

  1. Physical examination: The doctor will inspect the anal region to check if there is any visible tear. The patient’s symptoms and medical history are also noted.
  2. Anoscopy: A tubular device, called an anoscope, is inserted into the anus to help the doctor visualize the anus and rectum.
  3. Flexible sigmoidoscopy: A flexible, thin tube with a tiny camera is inserted by the doctor into the bottom portion of the colon in this test.
  4. Colonoscopy: A flexible tube is inserted into the rectum to inspect the entire colon in this test.

 

Anal fissures can be treated in the following ways:

1. Non-surgical treatment:

It can be performed in the following ways:

  1. Hydrocortisone (corticosteroid) containing creams, suppositories, or foams can help in the reduction of inflammation.
  2. Other types of creams and ointments that may aid in the treatment of anal fissures include: 
  3. Medicated creams aid in anal fissure healing.
  4. Topical muscle relaxants may be used to relax the anal muscles.
  5. Nitroglycerin or calcium channel blocker ointments may be used to relax the anal muscles and increase the healing rate by providing blood flow to the anorectal region.
  6. Anesthetic ointments aid in reducing the pain that could interfere with bowel movements.
  7. A botox (botulinum toxin type A) injection may be given into the anal sphincter. This injection paralyzes the anal sphincter muscle temporarily and provides pain relief. This aids in the healing of the anus.

2. Surgical Treatment :

Surgery may be recommended to treat anal fissures when the conservative, non-medical approach has failed. The surgeries are usually performed under general anesthesia, that is, the patient is made unconscious during the procedure. The different types of surgeries that can be performed include:

1. Lateral internal sphincterotomy:
It involves cutting the sphincter muscles from the outermost anal edge and allowing the anal fissure to heal.
This procedure can be performed in the following two ways:
a) Open sphincterotomy: The surgeon will make a small incision or cut in the skin to view the sphincter muscles. This cut is normally left open for healing.
b) Closed sphincterotomy: The surgeon will pass a blade under the skin and reaches the sphincter muscles to cut them.
This procedure may lead to incontinence (lack of control over urination).

2. Fissurectomy:
The anal fissure edges are surgically excised along with any skin tags that may be present due to anal tears. 
The sphincter muscle will not be cut in this procedure.
A cauterization tool is then used for sealing the entire wound area.
Lateral internal sphincterotomy gives immediate pain relief, compared to gradual pain relief achieved by fissurectomy. 
The chances of anal fissure recurrence are higher following a fissurectomy.

3. Anal advancement flaps:
A small portion of healthy skin is grafted in the place of the damaged skin in the anal fissure in this procedure.
This procedure is less likely to cause incontinence.

4. Laser surgery for anal fissure treatment:
This surgery is usually under local anesthesia, that is, the area of treatment is numbed during the procedure.
A carbon dioxide (CO2) laser is usually used in this procedure. It is used to concentrate on a fixed surgical area and offers more control over the surgery.
The infrared radiation from the laser is used to increase the blood flow to the anal fissure area. This helps in the proper healing of the anal fissure.
The healing is quicker and the chances of anal fissure recurrence are less in this procedure.

Anal fissure surgery may have the following complications:

  • Fever
  • Chills
  • Blood in stools
  • Inability to urinate
  • Incontinence (leakage) of stools 
  • Fainting
  • Prolonged pain
  • Dizziness
  • Increased bleeding
  • Blood clot formation
  • Pus discharge 
  • Tear that extends to the surrounding muscle
  • Recurrence of anal fissure 

 

  • You may have some tenderness in the anal area for one or two days after the surgery. The doctor will prescribe pain-relieving medications to relieve your discomfort.
  • Constipation and bleeding are commonly seen for the first few days after the surgery. 
  • You should avoid straining while passing stools.
  • Heavy lifting should be avoided for one or two days after the surgery.
  • Most patients can resume work approximately two weeks after the surgery.
  • Complete recovery after anal fissure surgery can take about six to ten weeks.

Home-remedies:

  1. Have a healthy lifestyle
  2. Exercise regularly
  3. Eat a high-fiber, nutrient-rich diet
  4. Take warm water baths
  5. Avoid tobacco and alcohol consumption
  6. Avoid processed food and red meat
  7. Avoid straining while passing stools
  8. Wipe your bottom gently from front backward after using the toilet

Cost :

The cost of anal fissure surgery in Mumbai is between INR 25,000 to INR 1,00,000.
The cost of anal fissure surgery in Delhi is between INR 20,000 to INR 90,000.
The cost of anal fissure surgery in Bangalore is between INR 20,000 to INR 90,000.
The cost of anal fissure surgery in Chennai is between INR 18,000 to INR 85,000.

Top Doctors for Anal Fissure Surgery in Chennai

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Anal Fissure Surgery

Anal fissures lead to pain and bleeding during bowel movements. It could also lead to spasms in the muscle ring at the end of the anus, known as an anal sphincter.
An anal fissure is commonly seen in young infants but could occur at any age. Most anal fissures can be treated by medications and self-care. However, some anal fissures may need surgical treatment.

Types: Anal fissures are of the following two types:

  1. Acute anal fissure: These types of anal fissures appear like a paper cut and usually go away on their own using non-surgical methods like medications, ointments, dietary changes, and by taking sitz (warm water) baths.
  2. Chronic anal fissure: These types of anal fissures last for more than two months and have deeper cuts. They usually need a surgical form of treatment.

Causes: The different causes of anal fissure include:

  • Chronic constipation
  • Chronic diarrhea
  • Anal sex
  • Straining during bowel movements
  • Inserting foreign materials into the anus
  • Passing of hard, large dry stools
  • Injury in the anal region
  • Blood flow disruption to the anorectal area
  • Underlying medical conditions like Crohn’s disease, sexually transmitted diseases, and anal cancer

Symptoms

The different symptoms associated with anal fissure include:

  • Difficulty in passing stools
  • Pain during bowel movements
  • Blood in stools
  • Tears in the anal canal
  • Painful urination
  • Burning and itching sensation in the anal region
  • Foul-smelling discharge from the anus

 

Diagnosis

  1. Physical examination: The doctor will inspect the anal region to check if there is any visible tear. The patient’s symptoms and medical history are also noted.
  2. Anoscopy: A tubular device, called an anoscope, is inserted into the anus to help the doctor visualize the anus and rectum.
  3. Flexible sigmoidoscopy: A flexible, thin tube with a tiny camera is inserted by the doctor into the bottom portion of the colon in this test.
  4. Colonoscopy: A flexible tube is inserted into the rectum to inspect the entire colon in this test.

 

Treatment

Anal fissures can be treated in the following ways:

1. Non-surgical treatment:

It can be performed in the following ways:

  1. Hydrocortisone (corticosteroid) containing creams, suppositories, or foams can help in the reduction of inflammation.
  2. Other types of creams and ointments that may aid in the treatment of anal fissures include: 
  3. Medicated creams aid in anal fissure healing.
  4. Topical muscle relaxants may be used to relax the anal muscles.
  5. Nitroglycerin or calcium channel blocker ointments may be used to relax the anal muscles and increase the healing rate by providing blood flow to the anorectal region.
  6. Anesthetic ointments aid in reducing the pain that could interfere with bowel movements.
  7. A botox (botulinum toxin type A) injection may be given into the anal sphincter. This injection paralyzes the anal sphincter muscle temporarily and provides pain relief. This aids in the healing of the anus.

2. Surgical Treatment :

Surgery may be recommended to treat anal fissures when the conservative, non-medical approach has failed. The surgeries are usually performed under general anesthesia, that is, the patient is made unconscious during the procedure. The different types of surgeries that can be performed include:

1. Lateral internal sphincterotomy:
It involves cutting the sphincter muscles from the outermost anal edge and allowing the anal fissure to heal.
This procedure can be performed in the following two ways:
a) Open sphincterotomy: The surgeon will make a small incision or cut in the skin to view the sphincter muscles. This cut is normally left open for healing.
b) Closed sphincterotomy: The surgeon will pass a blade under the skin and reaches the sphincter muscles to cut them.
This procedure may lead to incontinence (lack of control over urination).

2. Fissurectomy:
The anal fissure edges are surgically excised along with any skin tags that may be present due to anal tears. 
The sphincter muscle will not be cut in this procedure.
A cauterization tool is then used for sealing the entire wound area.
Lateral internal sphincterotomy gives immediate pain relief, compared to gradual pain relief achieved by fissurectomy. 
The chances of anal fissure recurrence are higher following a fissurectomy.

3. Anal advancement flaps:
A small portion of healthy skin is grafted in the place of the damaged skin in the anal fissure in this procedure.
This procedure is less likely to cause incontinence.

4. Laser surgery for anal fissure treatment:
This surgery is usually under local anesthesia, that is, the area of treatment is numbed during the procedure.
A carbon dioxide (CO2) laser is usually used in this procedure. It is used to concentrate on a fixed surgical area and offers more control over the surgery.
The infrared radiation from the laser is used to increase the blood flow to the anal fissure area. This helps in the proper healing of the anal fissure.
The healing is quicker and the chances of anal fissure recurrence are less in this procedure.

Risks

Anal fissure surgery may have the following complications:

  • Fever
  • Chills
  • Blood in stools
  • Inability to urinate
  • Incontinence (leakage) of stools 
  • Fainting
  • Prolonged pain
  • Dizziness
  • Increased bleeding
  • Blood clot formation
  • Pus discharge 
  • Tear that extends to the surrounding muscle
  • Recurrence of anal fissure 

 

After Procedure

  • You may have some tenderness in the anal area for one or two days after the surgery. The doctor will prescribe pain-relieving medications to relieve your discomfort.
  • Constipation and bleeding are commonly seen for the first few days after the surgery. 
  • You should avoid straining while passing stools.
  • Heavy lifting should be avoided for one or two days after the surgery.
  • Most patients can resume work approximately two weeks after the surgery.
  • Complete recovery after anal fissure surgery can take about six to ten weeks.

Home-remedies:

  1. Have a healthy lifestyle
  2. Exercise regularly
  3. Eat a high-fiber, nutrient-rich diet
  4. Take warm water baths
  5. Avoid tobacco and alcohol consumption
  6. Avoid processed food and red meat
  7. Avoid straining while passing stools
  8. Wipe your bottom gently from front backward after using the toilet

Cost :

The cost of anal fissure surgery in Mumbai is between INR 25,000 to INR 1,00,000.
The cost of anal fissure surgery in Delhi is between INR 20,000 to INR 90,000.
The cost of anal fissure surgery in Bangalore is between INR 20,000 to INR 90,000.
The cost of anal fissure surgery in Chennai is between INR 18,000 to INR 85,000.

FAQ Section

Q. What is an anal fissure?

A. A small tear in the anal canal (from where stools are excreted out of the body) lining at the end of the rectum (where stools are stored before being excreted out) is known as an anal fissure.

 

 

 

Q. Can an anal fissure develop at any age?

A. Yes, if you live a sedentary and unhealthy lifestyle, an anal fissure can develop at any age.

Q. What food should I avoid eating if I have an anal fissure?

A. You should avoid eating food that is low in fiber and could increase the risk of developing constipation, which is one of the main causes of anal fissure development. Other food items that you need to avoid eating if you have an anal fissure include:

  • Bagels
  • White bread
  • High-fat dairy products
  • Meat
  • Caffeinated beverages
  • Alcohol
  • Meat

Q. How does an anal fissure develop?

A. An anal fissure may occur due to the following reasons:

  • Chronic or long-term constipation
  • Chronic diarrhea
  • Straining during bowel movements
  • Insertion of foreign materials into the anus
  • Anal sex
  • Passing hard, large, dry stools
  • Injury or trauma to the anal region
  • Disrupted blood supply to the anorectal area
  • Underlying medical conditions like sexually transmitted diseases, Crohn’s disease, and anal cancer

Q. What is the difference between anal fissures and piles?

A. An anal fissure is a tear seen in the lining of the anus, whereas, piles are inflamed and swollen veins present within and outside the anal tract. Anal fissures usually cause severe pain even in the early stages, whereas, piles are usually painless and become noticeable only in the later stages.

 

Q. Can I develop piles, fistula, and fissures together?

A. Yes, although it is rare, there is a possibility that you may develop fistula, piles, and fissures together. If you have any one of the above anorectal diseases, and you leave it untreated for a very long time, you may become susceptible to the other diseases as well. It is therefore advisable to get treated as soon as possible.

Q. What symptoms will I have if I have an anal fissure?

A. You may have the following symptoms if you develop an anal fissure:

  • Difficulty in stool passage
  • Blood in stools
  • Pain during bowel movements
  • Anal canal tears
  • Painful urination
  • Burning sensation 
  • Foul-smelling discharge from the anus
  • Itching sensation 

 

Q. What is the cost of anal fissure surgery in India?

A. The cost of anal fissure surgery varies depending on the type of surgery performed and the condition of the patient.
The cost of anal fissure surgery also varies among different doctors in different hospitals. On average, the cost of anal fissure surgery in India varies between INR 20,000 to INR 1,00,000.

Cost of Anal Fissure Surgery in India
CITY COST
Mumbai INR 25000- INR 120000
Bangalore INR 20000- INR 100000
Delhi INR 20000- INR 100000
Chennai INR 20000- INR 100000

 

Q. Can I prevent anal fissures?

A. You may use the following tips to prevent anal fissure development:

  • Eat a fiber-rich diet
  • Drink lots of fluids throughout the day to stay hydrated
  • Exercise regularly 
  • Take laxatives only after consultation with the doctor 
  • Do not hold on to the urge to pass stools

 

Q. What are the complications of anal fissure surgery?

A. Anal fissure surgery could lead to the following complications:

  • Fever
  • Blood in stools
  • Chills
  • Inability to urinate
  • Incontinence
  • Fainting
  • Pain
  • Dizziness
  • Bleeding
  • Blood clot formation
  • Pus discharge 
  • Tear extending to the surrounding muscle
  • Anal fissure recurrence