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Laser Fissure Surgery

Laser Fissure Surgery

At our centre all patients are treated with Latest Laser surgery.

Laser Proctology is now the standard care for Piles (Hemorrhoids)/Fissure/Fistula/Pilonidal Sinus

Why you should choose Laser Fissure Treatment at BariOSS Centre

  1. Get treated by the Expert and 1st Laser Surgeon in South of Tamilnadu.
  2. Laser Fissure Treatment is the most advanced treatment.
  3. It is an FDA approved treatment.
  4. It is a Minimal Invasive Surgery, so no cuts & stitches.
  5. It’s only a 20 mins procedure.
  6. It can be done in with Spinal Anaesthesia / Short General Anaesthesia.
  7. Instant relief from existing pain and symptoms.
  8. Very minimal pain even after the surgery.
  9. No Blood Loss.
  10. No Scar post the laser fissure surgery.
  11. You can resume work the next day after the Laser Fissure Treatment.
  12. There has been no recurrence till date in our patients.

Anal Fissure

An anal fissure is a small tear in skin that lines the opening of the anus. Fissures typically cause severe pain and bleeding with bowel movements.  Fissures are quite common in the general population, but are often confused with other causes of pain and bleeding, such as hemorrhoids.

Anal fissures can occur at any age and have equal gender distribution.  85-90% fissures occur in the posterior midline (back) of the anus with about 10-15% occurring in the anterior midline (front).  A small number of patients may actually have fissures in both the front and the back locations.  Fissures located elsewhere (off to the side) should raise suspicion for other diseases (see below) and will need to be examined further.  

Symptoms of an Anal Fissure

The typical symptoms of an anal fissure include pain and bleeding with bowel movements.  Patients note severe pain during, and especially after a bowel movement, lasting from several minutes to a few hours.  Patients often notice bright red blood from the anus that can be seen on the toilet paper or on the stool.  Between bowel movements, patients with anal fissures are often relatively symptom-free.  Many patients are fearful of having a bowel movement and may try to avoid defecation secondary to the pain. 

Causes for Anal Fissure

Fissures are usually caused by trauma to the inner lining of the anus.  A hard, dry bowel movement is typically responsible, but loose stools and diarrhoea can also be the cause.  The injury to the tissue creates severe anal pain, resulting in anal sphincter spasm and a subsequent increase in anal sphincter muscle pressure.  The increase in anal sphincter muscle pressure results in a decrease in blood flow to the site of the injury, thus impairing healing of the wound.  Ensuing bowel movements result in more pain, more anal spasm, diminished blood flow to the area, and the cycle is propagated.

Types of Anal Fissure

Anal fissures may be acute (recent onset) or chronic (typically lasting more than 8-12 weeks).  Acute fissures may have the appearance of a simple tear in the anus, whereas chronic fissures may have swelling and scar tissue present. Chronic fissures may be more difficult to treat and may also have an external lump associated with the tear, called a sentinel pile or skin tag, as well as extra tissue just inside the anal canal, referred to as a hypertrophied papilla. 

Confusions for an Anal Fissure

Quite commonly, anal fissures are misdiagnosed as hemorrhoids by the patient or the primary care physician due to some similar symptoms between the two.  This delay in diagnosis may lead to an acute fissure becoming a chronic one and, thus, becomes more difficult to treat.  Misdiagnosis of an anal fissure may also allow other conditions to go undetected and untreated, such as serious infections or even cancer.  Less common causes of fissures include inflammatory conditions and certain anal infections or tumours, such as Crohn’s disease, Ulcerative Colitis, syphilis, tuberculosis, leukemia, HIV/AIDS, or anal cancer.  These diseases can cause atypical fissures that are located off the midline, are multiple, painless, or non-healing after proper treatment.  

What exams, procedures, and tests diagnose anal fissures?

Usually a gentle eversion (pulling apart) the edges of the anus by separating the buttocks may reveal a fissure but for few obese patients a more vigorous examination following the application of a topical anaesthetic to the anus and anal canal may be necessary.

An acute anal fissure looks like a linear tear. A chronic anal fissure frequently is associated with a tag of skin at the edge of the anus (sentinel pile), thickened edges of the fissure with muscle fibres of the internal sphincter and an enlarged anal papilla at the upper end of the fissure in the anal canal.

If rectal bleeding is present, an endoscopic evaluation using a rigid or flexible viewing tube is necessary to exclude the possibility of a more serious disease of the anus and rectum. A sigmoidoscopy that examines only the distal part of the colon may be reasonable in patients younger than 50 years of age who have a typical anal fissure. In patients with a family history of colon cancer or age greater than 50 (and, therefore, at higher risk for colon cancer), a colonoscopy that examines the entire colon is recommended.

Treatment of Anal Fissures

For most people the tear (fissure) heals within a week or so, just like any other small cut or tear to the skin.

Treatment aims to ease the pain and to keep the stools (faeces) soft whilst the fissure heals.

The majority of anal fissures do not require surgery.  The most common treatment for an acute anal fissure consists of making one’s stool more consistent with a diet high in fibre as well as utilizing over-the-counter fibre supplementation (totalling 25-35 grams of fibre/day).  Stool softeners and increasing water intake may be necessary to promote soft bowel movements and aid in the healing process.  Antidiarrheals may be needed for loose, frequent stools.

Topical creams can be used for anal pain and warm tub baths (sitz baths) for 10-20 minutes several times a day (especially after bowel movements) are soothing and promote relaxation of the anal muscles, helping the healing process.   

These non-operative measures will help achieve resolution of pain and bleeding and, potentially, heal greater than half of acute fissures with virtually no side effects.  Other medications may be prescribed, when a patient has a more chronic-type fissure, that promote relaxation of the anal sphincter muscles. Chronic fissures are generally more difficult to treat, and may require surgical treatment either as an initial treatment or following attempts at medical management. 

Easing pain and discomfort

  1. Warm baths are soothing and they may help the back passage (anus) to relax which may ease the pain.
  2. A cream or ointment that contains an anaesthetic & steroid medication may be prescribed by surgeon if there is pain and a lot of swelling (inflammation) around the fissure. Steroids reduce inflammation and they may help to reduce any swelling around a fissure. This may help to ease any itch and pain. You should not use it for longer than one week at a time.
  3. Wash the anus carefully with water after you go to the toilet. Dry gently. Don’t use soap whilst it is sore as it may cause irritation.
  4. Painkillers as given by the surgeon.

Avoid constipation and keep the stools soft

  1. Eat plenty of fibre which is found in fruit, vegetables, cereals, wholemeal bread, etc.
  2. Have lots to drink. Adults should aim to drink at least three litres of fluid per day. You will pass much of the fluid as urine. However, some is passed out in the gut and softens the stools.
  3. Fibre supplements and laxatives. If a high-fibre diet is not helping, you can take fibre supplements as given by the surgeon.
  4. Toileting. Don’t ignore the feeling of needing to pass stools. Some people suppress this feeling and put off going to the toilet until later. This may result in bigger and harder stools forming that are more difficult to pass later.

Anal fissures in children

The above measures apply to children who have a fissure as much as to adults. In children, the pain often makes them hold on to their stools. This may lead to a vicious circle, as then even larger and harder stools form. These then cause more pain when they are finally passed. Therefore, in addition to the above measures, a short course of laxatives may be given for children with an anal fissure. The aim is to make sure their stools are soft and loose whilst the fissure heals.

Will the Problem Return?

Fissures can recur easily, and it is quite common for a fully healed fissure to recur after a hard bowel movement or other injury.  Even when the pain and bleeding have subsided, it is very important to continue good bowel habits and a diet high in fibre as a sustained lifestyle change.  If the problem returns without an obvious cause, further assessment may be warranted. 

What can be done if the fissure does not heal?

A fissure that fails to respond to conservative measures should be re-examined.  Persistent hard or loose bowel movements, scarring, or spasm of the internal anal muscle all contribute to delayed healing.  Other medical problems such as inflammatory bowel disease (Crohn’s disease), infections, or anal tumours can cause symptoms similar to anal fissures.  Patients suffering from persistent anal pain should be examined to exclude these diseases.  This may include a colonoscopy and an exam in the operating room under anaesthesia with biopsies and tissue cultures. 

Surgery For Anal Fissure

Surgical options for treating anal fissure include surgical division of a portion of the internal anal sphincter (Lateral Internal Anal Sphincterotomy). It can be done by Open method and Laser method. The goal of these surgical options is to promote relaxation of the anal sphincter, thereby decreasing anal pain and spasm, allowing the fissure to heal.

Laser Lateral Internal Anal Sphincterotomy

Precise and controlled division of the internal anal sphincter muscle by laser is a highly effective method to treat acute or chronic and refractory anal fissures, with success rates reported to be over 90-95%.  Recurrence rates after sphincterotomy are exceedingly low.  The surgery is performed as day care procedure.  Patients undergoing Laser sphincterotomy have much improved quality of life as compared to patients with persistent anal fissures.

Opensphincterotomy procedure carry some risk and can rarely interfere with one’s ability to control gas and stool.In Laser there are no such risks and its safe and painless.

Recovery after Surgery

It is important to note that complete healing with both medical and surgical treatments can take up to approximately 1 or 2 weeks in Laser Sphincterotomy (6-12 weeks for an open Sphincterotomy). However, the pain after laser surgery often disappears in a day.  Most patients will be able to return to work and resume daily activities the next day after the surgery. 

Quick Tips

– Sitting in warm water (Sitz bath) provides great relief.

– Drink plenty of water to keep you hydrated.

– Try not to exert pressure while passing stools.

– Exercise regularly.

– Do not neglect or feel embarrassed if you have fissure. Consult our surgeon immediately.

So, just don’t be afraid! Having fissure is not the end of the world. There is no miracle fix. But, yes knowing what you need to know is surely going to help!

Please leave your queries in the comment or contact space and we will get right back to you with solutions.

Dr.Christopher S K

Consultant Advanced Minimally Invasive, Bariatric, GI and Laser Surgeon.
  • bariosscentre@gmail.com
  • 7708803335
  • Chennai, Madurai, Tirunelveli, Nagercoil, Tuticorin, Tenkasi

Dr.Christopher S.K

Consultant Advanced Minimally Invasive Bariatric, GI & Laser Surgeon

For Appointments

Call @ +91 7708803335 bariosscentre@gmail.com

FAQ Anal Fissure

Fissures are usually caused by trauma to the inner lining of the anus. Hard, dry bowel movement is typically responsible for this condition. Chronic constipation or frequent diarrhoea can also tear the skin around the anus. Other common causes of this condition include – straining during bowel movements/childbirth, reduced blood flow to the anorectal area, overly tight or spastic anal sphincter muscles and inflammatory bowel disease (IBD) such as Crohn’s disease and ulcerative colitis.

Anal fissures can be either acute or chronic. Acute (recent onset) fissures may have the appearance of a simple tear in the anus. Chronic fissures, on the other hand, may have swelling and scar tissue present and may typically last for more than 8-12 weeks. Chronic fissures may be more difficult to treat and may also have an external lump associated with the tear (called a sentinel pile or skin tag) as well as an extra tissue just inside the anal canal, referred to as a hypertrophied papilla.

Generally, fissures (about 85-90%) occur in the posterior (back) midline of the anus and about 10-15% occur in the anterior (front) midline of the anus. However, in some cases, a small number of patients may actually have fissures in both the front and the back locations. Fissures located elsewhere (off to the side) may increase the risk of complication related to other diseases and hence will require a detailed examination.

Pain and bleeding with bowel movements are typical symptoms of an anal fissure. Patients may experience severe pain during, and particularly after a bowel movement which may generally last for several minutes to a few hours. Other related symptoms include – bright red blood on the stool or toilet paper (after a bowel movement), a visible crack in the skin around the anus and a small lump or skin tag on the skin near the anal fissure.

Anal fissures can occur to both men and women. They are quite common during infancy as well. Adults in the age group of 20-40 years are most likely to suffer from this condition. Even though people can get this condition at any age, the risk generally increases as people get older. Older adults are also prone to anal fissures due to decreased blood flow in the anorectal area. During and after childbirth, women are at risk for anal fissures due to straining during delivery. Anal fissures more often occur with certain medical conditions such as constipation, anal cancer, leukemia, STDs and HIV and complications from other conditions, like Crohn’s or ulcerative colitis.

Yes, anal fissures can itch due to irritation of the tissue surrounding the anal canal, which can become very uncomfortable. To help stop the itch, make sure you thoroughly dry the area following a bowel movement. Don’t scratch the itch. This will prolong the itching and delay healing. Clean the area with a gentle cleanser and pat dry.

Blood in the stool or on toilet paper following a bowel movement is a common symptom of an anal fissure. However, ongoing or heavy bleeding may indicate a more serious condition, so talk with our surgeon right away if this occurs. With proper treatment, an anal fissure typically does not become infected. If your anal fissure does not heal in a timely manner, it’s possible the tear may become infected, which could require medication to heal.

No, anal fissures are not a risk factor of colorectal cancer. They also do not lead to colorectal cancer. It may seem that way because anal fissure symptoms, such as rectal bleeding and blood in the stool are possible symptoms of colorectal cancer. If you experience these symptoms after an anal fissure has fully healed, you should speak to our surgeon. Additional tests may be necessary to rule out more serious conditions, such as colorectal cancer.

One of the most prevalent complications of anal fissures is recurrence. They become more common after you initially have one. Another possible complication is a larger tear that reaches farther into the muscle surrounding the end of the rectum. This could be more difficult to treat and heal. Anal fissures that fail to heal within eight weeks are considered a chronic condition, which could require surgical treatment.

Staying hydrated and eating a high-fibre diet can help heal your anal fissure so it does not develop into a larger tear in the muscle. Use a mirror to examine your anus once a week. Do this every day during treatment and once a week thereafter. When you know what your healthy bottom looks like, you’ll be able to spot signs of a problem, such as increased redness, sores and bumps, and seek prompt treatment if necessary.

To help reduce your risk of anal fissures, it’s important to maintain a healthy diet that contains fibre and plenty of water. Take steps to promote healthy and regular bowel movements to reduce the stress on your anal canal.

An anal fissure cannot always be prevented, but it is possible to reduce the risk of suffering this condition by taking some preventive measures like –

  • Drinking plenty of fluids, eating fibrous foods
  • Exercising regularly to avoid constipation
  • Cleansing the anal area gently with mild soap and warm water
  • Keeping the anal area dry
  • Treating diarrhoea immediately
  • Avoid straining during bowel movements
  • For infants with this disease, change diapers frequently

Get Plenty of Fibre

If you're constipated, passing large, hard, or dry stools can cause an anal fissure. Getting plenty of fibre in your diet -- especially from fruits and vegetables -- can help prevent constipation, though.

Get 20 to 35 grams of fibre per day. Foods that are good sources include:

  • Wheat bran
  • Oat bran
  • Whole grains, including brown rice, oatmeal, popcorn, and whole-grain pastas, cereals, and breads
  • Peas and beans
  • Seeds and nuts
  • Citrus fruits
  • Prunes and prune juice

If you can’t get enough fibre through your diet, try fibre supplements (ask our surgeon).

Whether you eat more fibre-rich foods or take supplements, boost your intake gradually until you notice softer, more-frequent bowel movements. Also, drink plenty of liquids as you take in more fibre. This will help you avoid bloating and gas.

 

If you need a customized Diet Plan then take appointment with our Expert and Senior Dietician at BariOSS Centre

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