When Should You Consider Surgery, for Anal Fissures?

Anal fissures may sound like a small health issue, but for anyone who has experienced them, the pain and discomfort can be unbearable. A fissure is essentially a small tear in the delicate skin lining the anus. While minor fissures can often heal on their own with proper care, some cases become stubborn, recurring, or extremely painful. That’s when the thought of surgery often comes into the picture.

Understanding Anal Fissures

An anal fissure is a small cut or tear in the thin tissue that lines the anus. It usually occurs due to trauma, excessive straining, or passing hard stools. Even though the tear is small, it can cause sharp pain, bleeding during bowel movements, and a burning sensation afterward.

Many people mistake anal fissures for piles (hemorrhoids) since the symptoms are somewhat similar. However, they are different conditions:

• Hemorrhoids are swollen blood vessels inside or around the anus.

• Anal fissures are actual cuts in the skin around the anal opening.

Common Causes of Anal Fissures:

• Passing hard stools due to constipation

• Chronic diarrhea

• Straining during bowel movements

• Childbirth-related trauma

• Anal infections or inflammation

• Reduced blood flow to the anal region

Symptoms You Shouldn’t Ignore

The symptoms of anal fissures can vary from mild discomfort to intense pain. Common signs include:

• Sharp pain during and after bowel movements

• Bright red blood on toilet paper or in stool

• Burning or itching around the anus

• Visible tear or crack in the anal lining

• Spasm of the anal muscles, making it hard to pass stool

While some fissures heal within a few weeks, chronic fissures can persist for months, creating a vicious cycle of pain, constipation, and re-injury.

When Should You Consider Surgery for Anal Fissures?

Not every fissure needs surgery, but there are specific situations where doctors strongly recommend it:

1. Chronic or Non-Healing Fissures

If your fissure lasts more than 6-8 weeks despite medications and lifestyle changes, it’s considered chronic. Surgery offers a long-term cure.

2. Severe Pain That Affects Daily Life

Some fissures cause extreme pain during even simple activities like sitting, walking, or going to the toilet. If your quality of life is compromised, surgery becomes necessary.

3. Recurrent Fissures

Even after healing, some fissures come back repeatedly. Surgery helps break this cycle and prevents recurrence.

4. Anal Spasms

When the muscles around the anus (sphincter) become too tight, healing is delayed. Surgery can reduce muscle tension, promoting recovery.

5. Complications from Fissures

In rare cases, fissures can lead to infection, fistula formation, or abscesses. Surgery may be the only effective treatment.

Types of Fissure Surgery

If surgery is recommended, your doctor will discuss different options depending on your condition:

1. Lateral Internal Sphincterotomy (LIS)

• The most common surgery for chronic fissures.

• Involves making a small cut in the anal sphincter muscle to reduce tension and allow healing.

• Has a very high success rate and provides long-term relief.

2. Fissurectomy

• Involves removing the fissure and allowing fresh tissue to regrow.

• Usually recommended if LIS is not suitable.

3. Advancement Flap Surgery

• Used in complex or recurring fissures.

• Healthy tissue is moved to cover the fissure area, promoting healing.

4. Laser Surgery for Anal Fissures

• A modern, minimally invasive option.

• The laser precisely targets the fissure, reduces pain, and promotes faster healing.

• Less bleeding, quicker recovery, and lower recurrence compared to conventional methods.

• Especially suitable for patients afraid of traditional surgical cuts.

Benefits of Fissure Surgery

Patients who undergo surgery often report:

• Immediate pain relief

• Faster healing compared to medications

• Lower recurrence rates

• Ability to resume normal life within days

Risks and Considerations

Like any surgery, fissure procedures have some risks:

• Temporary incontinence (rare)

• Infection at the surgical site

• Bleeding

• Recurrence (though rare, especially after LIS or laser surgery)

Your surgeon will evaluate your condition carefully before recommending the best option.

Recovery After Surgery

Recovery is generally smooth if you follow post-operative instructions:

• Take prescribed medications regularly.

• Continue a high-fiber diet.

• Drink plenty of water to keep stools soft.

• Avoid straining during bowel movements.

• Practice good hygiene with sitz baths.

Most patients can return to work within 3–7 days after minimally invasive procedures, while complete healing may take a few weeks.

Living Without the Fear of Fissures

Anal fissures may not be life-threatening, but they can be life-altering due to the constant pain and anxiety. Surgery provides long-lasting relief when conservative methods fail. Thanks to modern techniques like laser fissure surgery, the procedure is safer, quicker, and more effective than ever before.

Final Thoughts

You should consider surgery for anal fissures if your condition is chronic, extremely painful, or keeps coming back despite lifestyle changes and medications. For many patients, surgery especially laser treatment offers a permanent solution and restores quality of life.

Ignoring fissures can worsen the condition, so timely medical consultation is key. Always discuss openly with your doctor to understand whether surgery is the right choice for you.