Dr. Ertan Beyatlı

How is Anal Fissure treated?

(Update: ) - Digestive System Diseases

What is an Anal Fissure?

Anal Fissure These are tears or cracks that occur longitudinally in the seat area (anus, breech, or anoderm). Tears extend inward from the outside but do not cross the dentate line. The most common causes are constipation, straining, childbirth and irregular eating habits.

The name of this disease can often be wrongly pronounced among the people; For example, fistula disease, fixture disease, fixture disease, and furuncle disease. The correct spelling is "Anal Fissure".

also Anal Fissure often among people Anal Fistula mixed with. These two diseases have only name similarity and refer to completely separate conditions. Fissure means crack or tear, fistula means channel or tunnel.


Causes of anal fissure include:

  • Large or hard stools
  • Constipationstrain and strain
  • Chronic diarrhea
  • Anal intercourse
  • Childbearing, pregnancy
  • Other: Crohn's disease, inflammatory bowel disease, Anal cancer, HIV, Tuberculosis (tuberculosis) and Syphilis.


Complaints vary according to the duration of the disease and the condition of the person's pain threshold.

  1. Rectal pain. Especially the pain that starts during defecation continues for 1-8 hours gradually, sometimes it can continue throughout the day.
  2. Breast formation in the anus.
  3. Itching in the anus.
  4. Bleeding in the anus. A small amount of light pink blood streaks may be seen during and after defecation.
  5. Burning in the anus. It is caused by the exposure of the nerves in the crack area, and it is more pronounced in the early period.
  6. The feeling of being scratched with glass. It is caused by the friction that stool makes on the crack as it passes through the anus.
  7. Difficult defecation. Due to the crack, it becomes difficult for the breech muscles to relax and cannot relax enough, so more straining is required to remove the stool.
  8. Constipation. The patient postpones the need for defecation for fear of pain, and therefore the water of the stool waiting in the intestine becomes more solid as it is absorbed more.
  9. Bloating The amount of gas and stool accumulated in the intestine increases due to delayed stool and increase in breech pressure.
  10. Stenosis in the anus. Uncontrolled contraction of the breech muscles is perceived as a functional stenosis. It is not a real stenosis and resolves spontaneously when the fissure is corrected.
  11. Burning sensation in urine. It is a rare condition and is seen because of the reflection of the feelings in the anus to the urinary tract.


There are two main types of anal fissures according to the duration:

  • Acute Anal Fissure. Its duration is one month. There may be severe pain and pinkish discharge or very little bleeding.
  • Chronic Anal Fissure. Cracks that persist for more than a month are called Chronic Anal Fissures. In chronic fissures, the rate of pain is less and sometimes painless bleeding may occur. In this case, a protective skin extension in the form of a breast occurs in the breech area. The name of this breast is "Skin Tag”Or“Guard nodule”Is. Its Latin is anal papilla hypertrophy. This situation often hemorrhoids (hemorrhoids) and leads to misdiagnosis and therefore incorrect treatment.
Anal Fissure (Anal Fissure)
Anal Fissure (Anal Fissure)

Anal Fissure Treatment

Acute anal fissures can be treated with medication. There are various drugs that regulate bowel habits and different local creams and suppositories applied to the anus area (breech crack cream). Surgical intervention and laser treatment options are available for chronic anal fissure.

Sphincterotomy and Fissurectomy

Local anesthesia The sphincter muscles, which cause involuntary contraction of the anus region underneath, are dissected with the help of electrocautery (Lateral internal sphincterotomy LIS). If necessary, the fissure floor is excised with cautery and burned (Fissurectomy). If the breast is present, it is removed.

The duration of this operation is 15-30 minutes on average. The patient can be mobilized and return home after the intervention. After the intervention, various medicines are given and warm water for up to 4-5 days. sitting bath recommended. The patient can return to work after 24 hours.

Some complications may occur after surgery such as: bleeding, hematoma, infection, gas or stool incontinence.

Anal progression flaps

Anal advancement flaps involve removing healthy skin from your anal lining and using it to cover the torn skin in your fissure. Healthy skin is fixed with stitches. This procedure is not done very often. This method can be used if the fissure still does not heal at the same time as or after the sphincterotomy. It may also be an option if you have a higher risk of developing stool incontinence after surgery.

Laser Anal Fissure Treatment

New generation laser devices (Neolaser), the anal fissure floor is dried. In this way, the risks and complications of surgery are eliminated. Neolaser procedure can be performed in the examination room with local anesthesia and the average duration is 5-10 minutes. Immediately after the procedure, the patient can return to work or home. In most patients, hemorrhoid nipples accompany anal fissure. In these cases, laser treatment emerges as a more comfortable option.

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You can also check my article here for Laser Hemorrhoids treatment: Hemorrhoids treatment with laser

How does Botox treat anal fissures?

Botox for anal fissures is essentially a non-surgical version of sphincterectomy, it helps relax the sphincter muscles and allows the fissures to heal. In many centers, people with anal fissures are encouraged to try Botox before resorting to surgery.

Botox consists of botulinum toxin, which is the poison that causes botulism. Small amounts of toxin paralyze the involuntary muscles in the anus ring and block signals. Anal fissure In this case, these muscles are the sphincter muscles. When botox is injected into the anus, your sphincter muscles become temporarily paralyzed and stop spasms, giving the anal fissure time to heal.

Deciding on treatment

The first time you meet with your doctor about your anal fissure, they will go through possible treatment options with you and make sure you understand what is involved. If they recommend a specific procedure, they will discuss what will happen before, during, and after, and any possible complications you may have.

This is your opportunity to ask questions to understand what is going to happen. You may choose to continue further treatment with creams and ointments. If you decide to continue with a procedure, you will be asked to sign a consent form (sometimes called the agreement form).

Before the procedure, you will be given information and instructions to follow, such as when to stop eating and drinking, and what will happen that day.

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