Anal Fissure Treatment in Bathinda — End Painful Stools for Good

An anal fissure is a small tear or crack in the thin, moist tissue (mucosa) lining the anus. It causes intense pain during and after bowel movements — often described as a "tearing", "burning", or "knife-like" sensation. Although not dangerous, an anal fissure can be debilitating and significantly affect quality of life. Many patients avoid going to the toilet because of the anticipated pain, leading to constipation and a vicious cycle. Dr. Raman Garg at Bombay Gastro & Cancer Institute, Bathinda provides expert treatment for both acute and chronic anal fissures.

Symptoms of Anal Fissure

• Severe pain during and after passing stool — the most prominent symptom (can last minutes to hours)
• Bright red blood on toilet paper or in the toilet bowl (usually small amount)
• Burning sensation around the anus after defecation
• Visible tear or crack in the skin around the anus
• Skin tag (sentinel pile) at the anal opening — in chronic fissures
• Spasm of the anal sphincter muscle
• Fear of defecation leading to constipation and worsening the fissure

Acute vs Chronic Anal Fissure

• Acute fissure: Fresh tear, present for less than 6 weeks. Edges are smooth. Responds well to medical treatment.
• Chronic fissure: Present for more than 6–8 weeks. Has indurated (hard) edges, exposed internal sphincter at the base, and a sentinel skin tag. Usually requires surgery for healing.

Causes of Anal Fissure

• Constipation with hard dry stools — most common cause. Hard stool stretches and tears the anal mucosa.
• Chronic diarrhoea — repeated injury to anal mucosa
• Childbirth injury — posterior or anterior fissures in women after difficult delivery
• Decreased blood flow to anal mucosa (ischaemic fissure) — especially in older patients
• Crohn's disease — atypical fissures, multiple, at unusual positions
• Previous anal surgery

Anal Fissure Treatment

Conservative (Medical) Treatment — For Acute Fissures

• High-fibre diet: 25–35 g/day of dietary fibre — softens stools and reduces trauma. Psyllium husk (ispaghula) supplements. Plenty of water.
• Sitz baths: Warm water soaks 10–15 minutes after each bowel movement — relaxes anal sphincter, improves blood flow, promotes healing
• Topical anaesthetics: Lignocaine (lidocaine) ointment — temporary pain relief before bowel movement
• Topical nitrates (GTN ointment): 0.2% glyceryl trinitrate — relaxes internal anal sphincter spasm, increases blood flow, promotes healing. Applied 2× daily for 6–8 weeks.
• Topical diltiazem cream (2%): Calcium channel blocker — relaxes sphincter. Better tolerated than GTN (fewer headaches).
• Stool softeners: Lactulose, polyethylene glycol
• Success rate for acute fissures: 50–70%

Botox Injection — For Persistent Fissures

Injection of botulinum toxin (Botox) into the internal anal sphincter causes temporary paralysis of the sphincter muscle (2–3 months), allowing the fissure to heal. Done as a day procedure under local anaesthesia. Success rate: 60–80%.

Lateral Internal Sphincterotomy (LIS) — For Chronic Fissures

Lateral Internal Sphincterotomy (LIS) is the gold standard surgical treatment for chronic anal fissure. A small portion of the internal anal sphincter is divided to permanently reduce resting anal pressure, allowing the fissure to heal. The procedure:

• Done under spinal anaesthesia — completely painless
• Takes 15–20 minutes
• Same-day discharge
• Significant pain relief within 24–48 hours (most dramatic improvement of any surgical procedure)
• Fissure heals within 4–8 weeks
• Success rate: 95–98%
• Very low risk of incontinence with correct technique (limited sphincterotomy)

Anal Fissure Prevention

• High-fibre diet (vegetables, fruits, whole grains) — prevents constipation
• Drink 2–3 litres of water daily
• Do not strain during defecation
• Do not ignore the urge to pass stool
• Exercise regularly to improve gut motility
• Treat diarrhoea promptly

Frequently Asked Questions — Anal Fissure Bathinda