Fissure-in-ano

A fissure in ano is a small tear or ulcer in the lining of the anal canal. It commonly causes sharp pain during or after passing stool and may be associated with bright red bleeding.

Fissures may occur due to constipation, hard stools, diarrhoea, straining, childbirth, or increased anal sphincter tone. Some fissures heal with medical treatment, while chronic or recurrent fissures may require surgery.

What to expect

Before Your Surgery

  • Authorization should be obtained prior to surgery and will be done by the hospital or the rooms staff depending on whether you are an in- or outpatient.
  • Make sure that you have been fasting for solid foods for at least 6 hours prior to your surgery and for clear liquids or water for at least 2 hours prior to your surgery. Discuss your chronic medications with your doctor or hospital staff prior to your surgery as you usually are allowed to take chronic medications the day of surgery, barring diabetic medication the day of the procedure. If you are taking any blood thinning medication please discuss these in detail with your doctor as special arrangements need to be made for these.

Day of Surgery

You will be admitted to hospital or day theatre. The procedure is usually performed under general or spinal anaesthesia. After the procedure, you will be monitored in recovery and discharged once stable.

Procedure

Initial treatment usually includes stool softeners, fibre, fluids, topical medication, pain control, and warm sitz baths.  For unexplained rectal bleeding colonoscopy would be advised.

If surgery is required, the procedure may involve a Lord's procedure (dilatation) or lateral internal sphincterotomy, where a small portion of the internal anal sphincter is divided to reduce pressure and allow the fissure to heal. In selected cases, associated skin tags or chronic scar tissue may also be removed.

Procedure Length

The procedure usually takes 15–30 minutes.

Possible Complications

  • Possible complications include bleeding, infection, pain, delayed healing, recurrence of the fissure, temporary or rarely permanent difficulty controlling gas or stool, and unintended damage to surrounding structures.

Duration of Hospital Stay

  • 1 day

Discharge Instructions

  • Take prescribed pain medication and stool softeners as directed. Avoid constipation and straining. Drink plenty of water and maintain a high-fibre diet.
  • Warm sitz baths may help with pain and hygiene. Mild bleeding or discharge may occur initially. Please contact the rooms if you develop fever, worsening pain, heavy bleeding, pus discharge, or difficulty controlling stool.

Return to Activities

  • Light walking is encouraged. Avoid heavy lifting, straining, cycling, and strenuous exercise for 1–2 weeks or until comfortable.

Back to Work Estimation

  • Desk work: approximately 3–5 days.
    Physically demanding work: approximately 1–2 weeks, depending on pain and healing.

Follow-Up and Results Discussion

A follow-up appointment may be arranged 5–7 days after surgery for wound and symptom review if necessary.

A further follow-up is usually arranged 10–14 days after surgery for assessment of healing, review of symptoms, and histology discussion if tissue was removed.