Doctors for Fissure

Anal fissures can be defined as lacerations or tears that occur on the skin surrounding the anal region. This condition often manifests as a painful sensation during bowel movements and may be accompanied by the presence of bright red blood spots. While anal fissures can affect individuals of all age groups, they are frequently observed in infants and middle-aged individuals. Fortunately, many cases of anal fissures can be managed at home without posing significant health risks. Mild cases may be addressed by utilizing stool softeners to alleviate discomfort or by incorporating pain relief medications. However, in instances where these measures prove ineffective, surgical intervention may be recommended.

When it comes to the treatment of anal fissures, various approaches can be considered based on the severity of the condition. These approaches can be broadly categorized into non-surgical and surgical methods. Read further to know these approaches in more detail;

• 1.Non-surgical Approach: The non-surgical approach is typically considered as the initial treatment for anal fissures, particularly in cases where the fissures are mild or in the early stages. It aims to provide relief from symptoms and promote healing without the need for invasive procedures.
1. Local Ointments: Following a physical examination, your doctor may prescribe topical medicines or jellies as local ointments. These formulations aid in reducing swelling, relieving pain, and alleviating inflammation associated with anal fissures.
2. Oral Medicines: To ease discomfort, doctors may recommend anti-inflammatory drugs in tablet, capsule, or syrup form. In addition, oral laxatives might be prescribed to soften stools and promote easier bowel movements.
3. Sitz Bath: Sitz baths are a common home remedy for pain relief. Taking sitz bath 2-3 times a day, can offer maximum comfort from the pain.
• 2. Surgical Approach: The surgical approach is considered when non-surgical treatments have been ineffective or when the anal fissure is severe, recurrent, or chronic. Surgical intervention aims to address the underlying issues causing the fissure and promote healing.
1. Lateral Internal Sphincterotomy: This surgical procedure involves cutting the sphincter muscles in the anal area to release tension and promote healing of the fissure. There are two methods for performing a sphincterotomy: an open sphincterotomy, where a small cut is made in the skin, leaving it open for healing, and a closed sphincterotomy, where a blade is passed under the skin to reach and cut the muscle. This surgical option is highly effective in treating anal fissures.
2. V-Y Advancement Flap: V-Y advancement flap surgery is used to treat complex or chronic fissures. During the procedure, a flap of tissue is created near the fissure and then advanced to cover the fissure site. This helps to promote healing and reduce the risk of recurrence. V-Y advancement flap is particularly useful in cases where the fissure is associated with a tight internal sphincter muscle.
3. Fissurectomy: During fissurectomy fissure is removed completely. It involves the excision of the damaged tissue to promote healing. This approach is typically used for chronic or recurrent fissures that have not responded to conservative treatments. Fissurectomy aims to eliminate the source of pain and allow the healthy tissue to regenerate.
4. Laser Fissure Treatment: Laser fissure treatment, also known as laser sphincterotomy, is a minimally invasive procedure performed using a specialized laser. The laser is used to make a small incision in the internal sphincter muscle, which helps to relax the muscle and improve blood flow to the area. This procedure is often preferred for its precision and minimal tissue damage, resulting in reduced post-operative pain and faster healing.

When it comes to determining the need for surgery in cases of anal fissures, several factors are taken into consideration. Here are the key considerations that indicate when a fissure may require surgical intervention;

• Chronic and Resistant Fissure: If you have a chronic anal fissure that is resistant to other conservative treatments, such as topical ointments, oral medications, or lifestyle modifications, surgery may be recommended. Chronic fissures are persistent and fail to heal despite attempts at non-surgical management.
• Severe Symptoms: Surgery may be considered when the symptoms associated with the anal fissure are severe and significantly affect your quality of life. These symptoms can include intense pain, frequent bleeding, difficulty in passing stools, and recurrent infections. Surgical intervention aims to provide long-term relief and improve overall symptoms.
• Recurrent Fissures: If you have experienced multiple episodes of anal fissures, indicating a pattern of recurrence, surgery may be advised. Recurrent fissures may indicate an underlying anatomical or functional issue that requires surgical correction for effective resolution.
• Failure of Non-surgical Treatments: When non-surgical approaches, such as medication, lifestyle changes, and sitz baths, have been attempted but have not provided satisfactory results or failed to achieve complete healing, surgery may be considered as a viable option.

When considering surgery for a fissure, proper diagnosis and evaluation of underlying conditions are essential. If your doctor suspects the presence of underlying diseases like Crohn's disease based on the nature of your fissure, they may recommend the following diagnostic tests;

• Anoscopy: This procedure involves the insertion of a small tube into the anus, providing the doctor with a clear view of the rectum and anal region. Anoscopy helps in identifying any abnormalities or inflammation that may be contributing to the fissure.
• Colonoscopy: If you are over 50 years old or have an increased risk of colon cancer, a colonoscopy may be recommended. During this test, a flexible tube is inserted into the rectum to visualize the entire colon. It allows the doctor to assess the health of the colon and rule out any additional complications.
• Flexible Sigmoidoscopy: This examination is typically performed on patients younger than 50 who do not have a significant risk of colon cancer. It involves the insertion of a long, thin, and flexible tube with a video camera at the end into the rectum. This allows the doctor to obtain a clear visual image of the inner lining of the rectum and lower part of the colon.

Fissure surgery is recommended by your healthcare provider when other conservative treatments have proven ineffective in managing chronic anal fissures or when the symptoms are severe. This surgical intervention offers a highly effective solution, despite a minor risk of incontinence:

• Before Surgery
1. To determine the need for surgery, your doctor will conduct a thorough physical examination, which may include a visual examination of the anal region. In certain cases, additional testing such as sigmoidoscopy or colonoscopy may be advised to rule out any underlying conditions or uncertainties in the diagnosis.
2. Patient Preparation: Fissure operation is typically performed under local anesthesia, although general anesthesia may be required for complex cases or patients who are anxious or uncooperative. The patient is positioned in a prone jack-knife position with the buttocks securely separated.
3. Anoscopy: During the procedure, an anoscope, a tubular instrument, is utilized to provide clear visualization of the rectum and anus.
4. Sigmoidoscopy: For patients below the age of 50 with no significant risk factors for colon cancer or gastrointestinal conditions, a thin, flexible tube with a small video camera at the end is inserted into the lower part of the colon to obtain a detailed image.
5. Colonoscopy: In cases where the patient is over 50 years old, or if there are risk factors or symptoms suggesting colon cancer or other related conditions, a flexible tube is inserted into the rectum to examine the entire colon.
• During the Surgery
1. The surgical procedure for anal fissures may involve different techniques, depending on the individual's condition. Here is a step-by-step description of two commonly used procedures;
2. Lateral Internal Sphincterotomy: Under general anesthesia, the surgeon performs a lateral internal sphincterotomy by cutting the sphincter muscles in the anal region to alleviate tension and facilitate healing of the fissure. The procedure typically takes a few minutes to complete. Post-surgery, patients may experience pain for a few days, and there is a minor risk of incontinence, although it often improves with time.
3. Anal Advancement Flaps: In this procedure, a piece of healthy skin is harvested and sutured to replace the damaged area of the fissure. Anal advancement flaps are generally recommended when the risk of incontinence is higher. However, it is considered less effective compared to lateral internal sphincterotomy.
• After the Surgery
1. Anal fissure surgeries are typically performed as day-case procedures, allowing patients to return home on the same day. It is important to rest until the effects of anesthesia have completely worn off.
2. While minor bleeding and anal discharge are common during the healing process, severe discomfort, excessive bleeding, or fever should be promptly reported to the healthcare provider.
3. By adhering to proper post-operative care and following the guidance of your medical team, you can expect a successful recovery from fissure treatment and experience relief from the symptoms associated with anal fissures.

Fissure operation offers numerous benefits that contribute to a swift recovery, reduced pain, and relief from associated symptoms. Other benefits of this surgical procedure are;

• Rapidity of Recovery: One of the key advantages of undergoing fissure surgery is the accelerated recovery time it offers. Following the procedure, many patients experience a significant improvement in their condition within a relatively short period.
• Pain Relief: Fissure surgery is often associated with a notable reduction in pain. By performing a sphincterotomy, the surgeon releases tension in the anal sphincter muscles, which are responsible for causing discomfort and spasms.
• Resolution of Symptoms: Aside from pain relief, fissure operation brings about relief from other associated symptoms. Anal fissures can cause various distressing symptoms such as bleeding, itching, and discomfort during bowel movements.
• Healing Promotion: Another significant benefit of fissure treatment is its ability to promote the healing of the fissure itself. By reducing tension in the anal sphincter muscles, the surgery allows for improved blood flow to the affected area, facilitating the healing process.

Fissure surgery, specifically lateral internal sphincterotomy, can have various side effects that patients should be aware of. While these side effects are not experienced by everyone, it is essential to understand and recognize them in order to seek prompt medical attention if needed;

• Infection: Infections are potential complications following fissure surgery. Although it is normal to experience some discharge and swelling after the procedure, persistent or worsening symptoms such as fever, severe pain, or delayed urinary retention should not be ignored.
• Bleeding: Both immediate and delayed bleeding can occur after fissure surgery. Minor bleeding is common, and patients may notice the passage of small clots and bright red blood during bowel movements. Bleeding within the first 24 to 48 hours after the procedure may be attributed to vascular pedicle loss of control.
• Risk of Fistula Development: Persistent drainage and non-healing wounds can increase the risk of fistula development.
• Incontinence: Incontinence is a potential post-operative complication and is often a significant concern for patients. It can result from pain-induced reflexes and irritation or blockage of pelvic nerves.
• Muscle Tear: In rare cases, the anal sphincter, nearby muscles, and nerves may sustain damage during or after surgery. Muscle tear may also lead to incontinence.

Recovering after fissure treatment is crucial to ensure proper healing and minimize the chances of recurrence. While anal fissures can often heal within a few weeks with the help of appropriate home remedies and medications that promote soft stool, the recovery time may vary depending on individual circumstances. In cases of chronic fissures or underlying conditions like Crohn's disease, the healing process may take longer. Here are some important steps to facilitate a speedy recovery;

• Take Adequate Rest: It is essential to avoid any strenuous activities for at least one week following the treatment. This allows the body to heal and reduces the risk of complications.
• Sitz Baths: Sitz baths are recommended three times a day. Additionally, it is advisable to take a sitz bath after each bowel movement in the initial days following the procedure. Sitz baths involve sitting in warm water for a specified period, which helps soothe the area, reduce inflammation, and promote healing.
• Maintain a High-Fiber Diet: Consuming a diet rich in fiber plays a vital role in preventing constipation, which can worsen or delay the healing of fissures. Include plenty of fresh fruits, vegetables, whole grains, and legumes in your meals. These fiber-rich foods add bulk to the stool, making it easier to pass.
• Stay Hydrated: It is important to drink an adequate amount of water throughout the day. Aim for 7-8 glasses of water daily to keep yourself well-hydrated. Sufficient hydration helps maintain soft and easy-to-pass stools, reducing the strain on the healing fissure.
• Medications and Ointments: Follow the instructions provided by your doctor regarding the use of over-the-counter medications and ointments. These may include pain relievers, stool softeners, or topical creams to alleviate discomfort and promote healing. It is crucial to use them as prescribed for optimal results.
• Follow-Up Appointments: Attend your scheduled follow-up appointments with your doctor. Typically, the first follow-up is recommended around three weeks after the treatment. These appointments allow the doctor to assess your progress, address any concerns or complications, and provide further guidance if needed.
• Maintain Good Hygiene: Practicing proper anal hygiene is essential for preventing infection and promoting healing. After each bowel movement, gently clean the area with mild, fragrance-free soap and warm water. Pat dry or use a soft towel to avoid irritation.
• Avoid Straining: To prevent undue pressure on the healing fissure, avoid straining during bowel movements. If you're experiencing difficulty passing stool, consider using a stool softener or gentle laxatives as recommended by your doctor.
• Be Patient: Healing takes time, and each individual's recovery may vary. It is important to be patient and give your body the necessary time to heal. Stress and anxiety can worsen symptoms, so practicing relaxation techniques, such as deep breathing exercises or meditation, may be beneficial.