Fissures

ABOUT THIS CONDITION

What is Fissures?

An anal fissure is a longitudinal tear in the anoderm — the specialised squamous epithelium of the anal canal. Acute fissures develop following passage of a hard stool and are usually posterior. They become chronic when they fail to heal due to internal anal sphincter spasm maintaining elevated resting anal pressure and reducing blood supply to the fissure base. Symptoms are severe anal pain during and after defaecation, often with bright red bleeding. Dr. Tagore Mohan Grandhi treats anal fissures at Lux Hospitals, Hyderabad. Acute fissures are managed conservatively with dietary modification, topical preparations (GTN or diltiazem), and botulinum toxin injection. Chronic fissures not responding to medical therapy are definitively treated with lateral internal sphincterotomy (LIS) — the gold-standard surgical procedure.

WHY IT HAPPENS

Causes & Risk Factors

• Passage of hard, bulky stool causing mechanical trauma to the anoderm
• Chronic constipation and prolonged straining
• Internal anal sphincter hypertonia reducing blood supply to the posterior commissure
• Chronic diarrhoea and repeated anal irritation in some cases
• Childbirth trauma causing anterior fissures in women
• Inflammatory bowel disease as an underlying cause of atypical fissures

HOW WE TREAT IT

Treatment Approach

1. 1

   Assessment & Conservative Trial

   Clinical examination confirms the diagnosis and excludes secondary causes (IBD, infection). Topical nitrates or calcium channel blockers and stool softeners are trialled for 6–8 weeks before surgical referral.

2. 2

   Botulinum Toxin Injection

   For fissures failing topical treatment, botulinum toxin injection into the internal sphincter is performed as an outpatient procedure, providing temporary sphincter relaxation and healing in 70–80% of cases.

3. 3

   Lateral Internal Sphincterotomy

   For chronic fissures failing conservative measures, LIS is performed as a day-case procedure under local or spinal anaesthesia. The lower portion of the internal sphincter is divided laterally, reducing pressure and allowing the fissure to heal.

4. 4

   Post-operative Care

   A high-fibre diet, adequate hydration, and stool softeners are maintained post-operatively. Most patients are pain-free within 2–4 weeks and return to work within 1–2 days.