What is a fissure?

A fissure is a cut in the anal canal which is partially inside and partially on the skin surrounding the anus.

How will I know that I have fissure?

Most common symptom fissure has is severe pain in anal area while passing motion or sometimes throughout the day. Pain is of high intensity in acute fissure and when the problem becomes chronic(long standing) there is a dull pain in anal area.

Along with pain there is bleeding while passing motion and this blood is most commonly seen as a streak(line) along the motion or as drops after passing motion.

In chronic fissure the bleeding is usually not visible.

Once fissure is there fo a long time there develops a thickening of skin near the anal canal which one can feel while cleaning and is known as sentinel pile.

If you have any of these symptoms you should consult a doctor who would do a local examination and usually with acute fissure even spreading the buttocks is painful.

What are the treatment options for fissure?

Any treatment dealing with fissure should be targeted at relaxing the anal canal by relaxing the sphincter. Sphincter is a rubber band like structure around the anus which becomes very hard and contracted due to presence of fissure and once it gets contracted it does not allow the fissure to heal.

A normal anal opening should allow painless passage of two fingers and this is achieved surgically by doing SPHINCTEROTOMY. This can be done via open method and by DIODE LASER.

I had pain/bleeding which was diagnosed as fissure but it resolved with medications. Now I don’t have any pain/bleeding. What should I do?

It is true that many times bleeding and pain of fissure resolves with medications. One must seek medical examination by a surgeon to assess the grade of fissure. In early stages fissure might be managed conservatively with medication and if you carefully follow dietary advise you may never have fissure again but if it doesn’t respond to medications and if it keeps happening again and again it needs surgical intervention. If you leave the problem unattended gradually you might end up with complications.

What are the possible complications of fissure?

If untreated fissures can get infected leading to formation of pus collection known as perianal abscess.

Over a period of time you may develop a fistula in ano.

If I have the fissure surgery will it affect my digestion and do I need to be on lifelong dietary restrictions, will there be narrowing of anal canal, will I loose my ability to hold motions?

There are no specific dietary restriction but yes you would be advised to take healthy diet and avoid constipation. Though after surgery for initial couple of days you will be kept on a liquid diet.

With advancements in fissure surgery there is no risk of narrowing of anal canal and there is no change in ability to hold motions.

What are the preparations required before surgery and what should I expect during hospital stay and after discharge?

The preparation for surgery will be started from the outpatient department (OPD). You will be advised to undergo a few tests to assess your body functions and a pre-anaesthetic check-up (PAC) will be done by an anaesthesiologist (a specialist doctor) who will assess your fitness for anaesthesia.

Most likely you will be admitted on the day of surgery unless you have some specific concerns which warrant some extra stay before the surgery.
You will be advised not to eat or drink anything from midnight of the day prior to surgery and not to eat or drink anything on the morning of admission as well. If you take some medications regularly in the morning than please do not forget to discuss regarding them with your doctor so that he advices you on which medicine to take and which not to take.

Upon admission some paper work will be done and you will be asked to sign consent forms for anaesthesia and surgery.

You will be asked to change in to hospital clothing, shaving of the area will be done and you will be given some intravenous medications and an enema.

Once the preparations are done you will be wheeled into the preoperative area where nursing staff and doctors will confirm your identity and then you will be shifted to the operating room.

Your anaesthetist will put you under spinal or general anaesthesia and then surgery will start. Usually it takes about one hour for the surgery to be over and then you will be shifted to post-operative recovery area in conscious state. You will be kept there for couple of hours and then you will be shifted to your designated room.

A catheter (pipe) might be put to drain out urine for maximum 24 hours and will be removed before you are Sent home.

You will be discharged to home the day after the surgery. You will be advised some medications on your discharge. You will be advised to take liquid diet at home for five days and then gradually you can start having normal diet.

Usually if all goes well you will be called for a visit to OPD five days after discharge.

How soon can I resume work after surgery? How much bed rest is advised? Is there any specific season of year when I should opt for surgery?

No bed rest is advised. You will be encouraged to walk about on your own from the next day of surgery. You can resume normal household work two days after surgery. Climbing stairs will not be a problem.

You may start driving one week after the surgery.

After a week you can resume walking. For a month you would be advised not to do weight training, running, jogging, cycling, yoga. You can resume all of this gradually after a month from the date of surgery.

Considering that almost all hospitals and households have air conditioning the season has become irrelevant so you can plan surgery as per the need and convenience anytime round the year.