Anal Fissure : Laser Treatment

December 21, 2021

What is an anal fissure?

An anal fissure is a tear in the lining of the anus or anal canal. The anal fissure can be extremly painful and may bleed.

What are the causes of an anal fissure?

Usually, trauma to the anal canal causes a fissure.

Common causes of anal fissure include:

• Passing large or hard stools
• Constipation and straining during bowel movements
• Chronic diarrhea
• Inflammation of the anorectal area, caused by Crohn’s disease or another inflammatory bowel disease
• Childbirth

Less common causes of anal fissures include:

• Anal cancer
• HIV
• Tuberculosis
• Syphilis
• Herpes

What are the signs and symptoms of an anal fissure?

Signs and symptoms include:

• Pain during, and even hours after — a bowel movement
• Constipation
• Blood on the outside surface of the stool
• Blood on toilet tissue or wipes
• A visible crack or tear in the anus or anal canal
• Burning and itch that may be painful
• Discomfort when urinating, frequent urination, or inability to urinate
• Foul-smelling discharge

A history of your symptoms followed by external inspection of the anus is enough to confirm the diagnosis.

How is an anal fissure treated?

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.

Acute fissures which do not heal with conservative therapy and most of the Chronic fissures need a surgical line of treatment.

You can treat an anal fissure at home by:

• using over-the-counter stool softeners
• drinking more fluids
• taking fibre supplements and eating more fibrous foods, such as raw fruits and vegetables
• taking warm baths called sitz baths to relax the anal muscles, relieve irritation, and increase blood flow to the anorectal area
• applying a nitroglycerin ointment to the anus to promote blood flow to the area or a hydrocortisone cream, to help with inflammation
• applying topical pain relievers, such as lidocaine, to the anus to ease discomfort.

If your symptoms aren’t relieved within two weeks of treatment, see your doctor for further evaluation. If your anal fissure fails to respond to other treatments, your doctor may recommend an lateral internal anal sphincterotomy. This surgical procedure involves making a small incision in the anal sphincter to relax the muscle. Relaxing the muscle allows the anal fissure to heal.

The main risks of internal sphincterotomy are variable degrees of stool or gas incontinence. If any incontinence is present after surgery, it may resolve over a short time period.

Laser Fissurectomy

A fissurectomy by laser is the removal of the fissure. The laser is used to perform internal sphincterotomy. This procedure is almost bloodless and the surgeon has good control over the operation site. Additionally, the chronic fibrosed scar is debrided with the laser. This prevents any long-term discomfort and enables a quicker recovery. This procedure is so simple, it needs less than five minutes to complete it. It is done without an incision, stitches, or complicated surgery. Most patients are back to their work on the same day and 90% of the pain is immediately gone, the rest of the 10% will need few weeks to disappear once the body forms a good thick skin layer over the fissure. In most cases, we, almost always, combine this treatment with laser ablation to the patient’s internal hemorrhoids blood supply.

What is the advantage of the laser treatment for anal fissure?

Dr. Gaurav Bansal
M S