Treatment of anal fissures

• Our treatment pathway follows a logical, patient‑centred progression: conservative management for acute fissures, then non‑surgical and minimally invasive options for chronic or resistant cases, and finally surgical intervention when necessary.
• For many patients, especially those with acute fissures, simple measures can allow the tear to heal completely. Conservative treatment is the first‑line approach and may be all that is needed.

Key components include:

• Dietary modifications: Increasing fibre intake through fruits, vegetables, whole grains, and legumes. Adequate hydration (2‑3 litres of water daily) is equally important
• Stool softeners: Over‑the‑counter stool softeners (e.g., docusate sodium) may be recommended to reduce straining during bowel movements
• Warm sitz baths: Soaking in warm water for 10‑15 minutes two to three times daily, particularly after bowel movements, helps relax the anal sphincter, reduce spasm, and promote blood flow to the area
• Topical ointments: Prescription creams such as nitroglycerin or calcium channel blockers (e.g., nifedipine, diltiazem) are applied directly to the fissure. These medications relax the anal sphincter, increase local blood flow, and facilitate healing. Lidocaine‑based creams may also be used for temporary pain relief

Most acute fissures improve within two to four weeks with conservative care alone. If symptoms persist beyond six weeks, the fissure is considered chronic and additional intervention may be needed.

When conservative treatment fails to heal a chronic fissure, Botox injection is a highly effective, minimally invasive alternative before considering surgery. Botulinum toxin is injected directly into the internal anal sphincter muscle, where it temporarily relaxes the muscle, reduces spasm, and allows the fissure to heal naturally.

Key advantages of Botox for anal fissures:

• Minimally invasive – performed in an outpatient setting without incisions
• No general anaesthesia required; the procedure is done with local anaesthesia
• No bowel preparation needed before the injection
• Short procedure time (approximately five minutes)
• Pain reduction begins within 1‑2 weeks, with maximum improvement at around four weeks
• The effect lasts for approximately three months, usually long enough for the fissure to heal completely
• Offers a very low risk of incontinence compared to traditional surgery

Вotox is widely recognised as a safe and effective second‑line treatment for chronic anal fissures, and it is often preferred by patients who wish to avoid surgery. Not every patient is a candidate, however; Dr. Lassu will assess your individual situation during consultation.

When fissures persist despite conservative measures and Botox, or when they are associated with significant scar tissue or severe spasm, surgery may be the most appropriate option. Surgery is also indicated for fissures that have led to complications such as anal stenosis or large, painful skin tags.

• Lateral Internal Sphincterotomy (LIS) – the gold‑standard surgical procedure for chronic anal fissure. During this procedure, a small, controlled incision is made in the internal anal sphincter muscle to reduce tension, relieve spasm, and allow the fissure to heal. LIS offers a high success rate with a low risk of recurrence. Dr. Lassu performs LIS with meticulous technique to minimise the risk of incontinence.
• Fissurectomy – involves surgical removal of the fissure and any surrounding scar tissue. This may be performed alone or in combination with Botox injection. Fissurectomy is sometimes preferred for patients with large, non‑healing ulcers or when other surgical options are contraindicated.

• Laser fissure treatment – an alternative, minimally invasive option that uses a fine laser fibre to deliver energy directly to the fissure area. Laser treatment reduces sphincter spasm, improves blood flow, and removes scar tissue, promoting natural healing. It is performed as a same‑day procedure under anaesthesia, with less pain and a faster recovery than traditional surgery.

Recovery after surgical treatment is generally rapid. Most patients return to normal daily activities within a few days to one week. Dr. Lassu provides clear post‑operative instructions, including dietary advice, stool softeners, sitz baths, and pain management, to ensure optimal healing.

• Choosing ELEMENTAL means receiving expert care in a discreet, professional, and patient‑centred environment. We understand that discussing anorectal symptoms can be difficult, and we prioritise your comfort, privacy, and safety at every step.
• Stepwise, conservative‑first approach: Dr. Lassu believes in exhausting non‑surgical options before recommending surgery. You will never be pushed toward an operation that you do not need.
• Modern facilities, same‑day convenience: Our DHA‑licensed day surgical centre is equipped with state‑of‑the‑art diagnostic and therapeutic equipment. Most consultations, injections, and laser procedures are completed on an outpatient basis – you return home the same day.
• Transparent care with clear communication: We explain every diagnosis, treatment option, and possible outcome in simple, clear language, so you can make informed decisions about your health. No misleading claims, no guarantees of specific results – only honest, professional advice.
• Seamless coordination: If a colonoscopy or other investigation is required to exclude other colorectal conditions, we can arrange it on‑site without long waiting times.

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Living with the pain and embarrassment of an anal fissure is not necessary. A thorough assessment and a personalised treatment plan can restore your comfort and quality of life.