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Anal Fissure Treatment: Importance, Types, Cost, and Care

Anal fissures are a common and often painful condition characterised by a small tear in the lining of the anus. They can cause significant discomfort and are frequently confused with other conditions like haemorrhoids. We have already discussed fissures and their signs and symptoms. This article aims to provide a comprehensive overview of anal fissures, including their causes, symptoms, treatment options, and preventive measures.

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What is Anal Fissure?

An anal fissure is a small tear or crack in the thin, moist tissue lining the lower rectum, near the anus. This condition is prevalent among both infants and adults, often leading to pain and bleeding during bowel movements. Unlike haemorrhoids, which are swollen blood vessels, fissures are tears in the skin, typically resulting from trauma or injury to the anal canal.

Why Anal Fissure Treatment Important?

It's important to treat anal fissures right away to avoid problems like long-term pain, infection, or a chronic fissure that's hard to heal. If left untreated, fissures can cause ongoing discomfort and might even require more complicated treatments later on.

When to See a Doctor for Anal Fissure Treatment

If you're experiencing painful bowel movements, bleeding, or signs of infection like swelling or discharge, it's a good idea to see a doctor. These symptoms could be a sign of a more serious condition that needs medical help..

Non-Surgical Treatment Options

Anal fissures, small tears in the lining of the anus, can cause significant discomfort and pain. Fortunately, there are ways to treat it without surgery. By making some changes to your daily routine and using certain medicines, you can feel better. Here are some non-surgical options to consider:

Dietary Modifications

Eating a healthy diet rich in fruits, vegetables, and whole grains can help prevent constipation, which is a common cause of anal fissures.

Incorporating more fibre-rich foods into your diet can also help regulate bowel movements and prevent constipation. Aim for at least 25-30 grams of fibre per day from sources such as:

  • Fruits: berries, citrus fruits, apples, bananas
  • Vegetables: broccoli, carrots, sweet potatoes, leafy greens
  • Whole grains: brown rice, quinoa, whole wheat bread, whole grain pasta
  • Legumes: beans, lentils, peas

Increasing your water intake can also help soften stools and reduce straining during bowel movements. Aim for at least 8-10 glasses of water per day, and consider incorporating herbal teas or other low-calorie beverages to help meet your daily hydration needs.

Some specific dietary changes that may be beneficial for individuals with anal fissures include:

  • Avoiding foods that can cause constipation, such as dairy products, processed foods, and foods high in sugar
  • Incorporating probiotics, which can help regulate the gut microbiome and promote healing
  • Avoiding spicy or acidic foods, which can irritate the anal area and exacerbate symptoms
  • Incorporating omega-3 fatty acids, which can help reduce inflammation and promote healing

Topical Treatments

There are several topical treatments that can help manage anal fissures. These include:

  • Nitroglycerin Ointments: These help relax the muscles in your anus, reducing pain and promoting healing.
  • Calcium Channel Blockers: These medications also help relax the muscles and improve blood flow to the affected area.
  • Over-the-Counter Creams: Hydrocortisone and lidocaine creams can provide temporary relief from pain and itching.

These treatments are applied directly to the affected area and can help reduce pain and promote healing.

Sitz Baths

  • A sitz bath is a simple way to soothe irritation, reduce inflammation, and promote healing.
  • The warmth can help relax your muscles and improve blood flow, which can accelerate the healing process.

Medications

Oral medications can also help manage anal fissures. These include:

  • Stool Softeners: These help prevent constipation by making stools easier to pass.
  • Pain Relievers: Over-the-counter pain medications like ibuprofen or acetaminophen can help manage discomfort.
  • Anti-Inflammatory Drugs: These can reduce swelling and pain, aiding in the healing process. By combining these non-surgical treatments, you can often find relief and promote healing without the need for more invasive procedures.

Minimally Invasive Procedures

Minimally invasive procedures offer effective treatment options for anal fissures without the need for surgery. These procedures are less invasive and can provide significant relief from symptoms.

Botox Injections

  • How it works: Botox injections are used to relax the anal sphincter muscles, reducing spasms and allowing the fissure to heal more effectively.
  • Benefits: Botox injections can provide quick relief from pain and promote healing by reducing muscle tension.

Dilation

  • How it works: Anal dilation involves gently stretching the anal canal to reduce sphincter pressure and promote healing.
  • Benefits: Dilation can help reduce pain and promote healing by decreasing sphincter pressure and improving blood flow to the affected area.

Surgical Treatment Options

Surgical treatments are considered for chronic anal fissures that do not respond to conservative treatments. These procedures aim to reduce muscle tension and promote healing.

Lateral Internal Sphincterotomy

Lateral internal sphincterotomy is the most common surgical treatment for chronic anal fissures.

  • Recovery Time: Recovery from lateral internal sphincterotomy is generally quick, with most patients experiencing relief from symptoms within a few weeks. Post-operative care includes sitz baths and avoiding strenuous activities.
  • Success Rates: This procedure has a high success rate, with most patients experiencing significant relief from symptoms. However, there is a small risk of complications such as incontinence.

Anal Advancement Flap

The anal advancement flap procedure is a less common surgical option used for severe or chronic fissures.

  • Recovery Time: Recovery from an anal advancement flap procedure can take several weeks. Patients are advised to follow a post-operative care plan that includes sitz baths and avoiding strenuous activities.
  • Success Rates: The anal advancement flap procedure has a good success rate, especially for chronic fissures that have not responded to other treatments. However, it may have a slightly higher risk of complications compared to lateral internal sphincterotomy.

Risks and Complications in Fissure Treatment

While fissure treatments are generally safe and effective, there are some potential risks and complications to be aware of. By understanding these risks, you can better discuss your treatment options with your healthcare provider and make informed decisions about your care.

  • Infection: It is a rare but possible complication of fissure treatment. This can occur if bacteria enter the wound during the healing process, leading to inflammation and infection.
  • Incontinence: It is another potential complication of fissure treatment, although it is relatively rare. This can occur if the muscles in the anal sphincter are damaged during the treatment process, leading to involuntary loss of bowel movements.
  • Recurrence: Recurrence of the fissure is also a possibility, especially if the underlying cause of the fissure is not addressed. This can occur if the fissure is not fully healed or if the patient experiences further trauma to the area. You can contact our specialists at SCI Hospital to avoid complications.

Dr. Shambhav Chandra

MBBS, MS - General Surgery, General Surgeon,Bariatric Surgeon,Laparoscopic Surgeon

  • General Surgeon,Bariatric Surgeon,Laparoscopic Surgeon
  • 11+ Years Experience

How Anal Fissure Treatment is Done?

Understanding how each treatment is administered can help patients prepare and manage their expectations.

Non-Surgical Treatments

Non-surgical treatments are often the first line of approach for managing anal fissures. These include:

  • Topical Ointments: Topical treatments such as nitroglycerin ointments and calcium channel blockers are applied directly to the affected area. 
  • Sitz Baths: Sitz baths involve soaking the affected area in warm water for 10-15 minutes, several times a day. 

Minimally Invasive Procedures

For fissures that do not respond to non-surgical treatments, minimally invasive procedures may be considered. These include:

  • Botox Injections: Botox is injected into the anal sphincter to relax the muscles, allowing the fissure to heal more effectively. This procedure is typically performed in a clinical setting under local anaesthesia.
  • Anal Dilation: Anal dilation involves gently stretching the anal canal to reduce sphincter pressure and promote healing. This procedure can be effective for chronic fissures that do not respond to other treatments.

Surgical Treatments

Surgical options are considered for chronic fissures that do not respond to other treatments. These include:

  • Lateral Internal Sphincterotomy: It involves making a small incision in the internal anal sphincter to reduce muscle tension and promote healing. The procedure has a high success rate and typically results in quick recovery.
  • Anal Advancement Flap: It involves covering the fissure with a flap of healthy tissue to promote healing. This procedure is generally reserved for cases where other treatments have failed.

Cost of Anal Fissure Treatment

Cost of Non-Surgical Treatments

Non-surgical treatments for anal fissures are generally more affordable and include medications, topical ointments, and lifestyle modifications. The costs can vary based on the specific products and brands used:

  • Medications: Over-the-counter stool softeners and pain relievers are typically inexpensive, ranging from 100 to 1000 rupees per month.
  • Topical Ointments: Prescription ointments like nitroglycerin or calcium channel blockers can cost between 200 to 1000 rupees, depending on the brand and insurance coverage.

Cost of Minimally Invasive Procedures and Surgery

The costs of minimally invasive procedures and surgical options for treating anal fissures can vary widely, influenced by several factors:

  • Minimally Invasive Procedures: Botox injections may cost around ₹40,000 to ₹80,000, depending on the healthcare provider and location. Anal dilation procedures are generally less costly but still depend on the clinic's pricing.
  • Surgical Options: Lateral internal sphincterotomy, a common surgical procedure, can range from ₹1,00,000 to ₹2,50,000. The cost may be higher in private hospitals compared to public ones.

Post-Treatment Care and Recovery 

Immediate Post-Treatment Care

After undergoing treatment for an anal fissure, it's important to focus on immediate recovery to ensure optimal healing. Patients can expect some discomfort, which can be managed with prescribed pain relievers. It's crucial to follow the doctor's instructions regarding activity restrictions, such as:

  • Avoiding heavy lifting
  • Avoiding strenuous activities
  • Gentle activities, such as:
  • Sitz baths can provide relief from pain and burning sensation and promotes healing.
  • Good hygiene practices:
    • Keeping the area clean
    • Keeping the area dry
  • Precautions to prevent infection and further irritation:
    • Maintaining good hygiene
    • Keeping the area clean and dry

Long-Term Care and Prevention

Long-term care is essential to prevent the recurrence of anal fissures.

  • Adopting a high-fibre diet
  • Staying hydrated to ensure regular bowel movements and avoid constipation
  • Incorporating whole grains, fruits, and vegetables into your diet
  • Regular exercise, such as walking, to improve bowel function and overall health
  • Responding promptly to the urge to defecate
  • Avoiding straining during bowel movements
    Regular follow-ups with a healthcare provider are recommended to:
  • Monitor healing
  • Address any concerns
    By following these strategies, patients can:
  • Significantly reduce the risk of developing new fissures
  • Maintain overall anal health.

Conclusion

Anal fissures, though painful, are manageable with proper care and lifestyle adjustments. Understanding the causes and symptoms can aid in effective prevention and treatment. By following the recommended post-treatment care and long-term prevention strategies, individuals can minimise discomfort and prevent recurrence. Consulting with a healthcare provider ensures that the chosen treatment approach is tailored to individual needs, promoting a faster and more effective recovery.

FAQs

Gastroenterologists or colorectal surgeons typically treat anal fissures. For expert consultation and treatment, consider visiting SCI Hospital.

Nitroglycerin ointments and calcium channel blockers are commonly recommended. Consult a healthcare provider at SCI Hospital for personalised advice.

Treatment varies but often includes dietary changes, topical treatments, and, if needed, surgical intervention. Consult with a specialist at SCI Hospital to determine the best approach for your condition.

Yes, most acute fissures heal with conservative treatments. However, chronic fissures may require surgical intervention. Discuss your options with a healthcare provider at SCI Hospital.

Recovery typically takes a few weeks, with most patients experiencing relief shortly after the procedure. Follow-up care at SCI Hospital can help ensure a smooth recovery.

Many insurance plans cover treatment, but coverage can vary. Check with your insurance provider and consult with SCI Hospital for more information.

Stool softeners and pain relievers are commonly used. Consult a healthcare provider at SCI Hospital for specific medication recommendations.

Combining a high-fibre diet with topical treatments can expedite healing. Consult with a specialist at SCI Hospital for personalised guidance on managing and treating anal fissures.

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Written By: Dr. Nabanita Chatterjee
Education: MBBS, MS - General Surgery
Experience: 30 Years

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