Anal Fissure Treatment in Turkey: Non-surgical options, surgery & recovery

What Is an anal fissure and what causes it?

An anal fissure is a small tear in the skin lining the anal canal, most often caused by the passage of hard or large stools. Common contributing factors include:

• Chronic constipation or straining during bowel movements
• Severe or prolonged diarrhea.
• Childbirth.
• Reduced blood flow to the anal area (more common with age).
• Underlying conditions such as Crohn's disease, in some cases.

Typical symptoms:

• Sharp, burning pain during and after bowel movements, sometimes lasting several hours.
• Bright red blood on the stool or toilet paper.
• A visible tear or skin tag near the anus.
• Anal itching or spasm of the anal sphincter, which can intensify the pain.

How is an anal fissure diagnosed?

A proper diagnosis is important because anal fissures share symptoms with other conditions, such as hemorrhoids, anal fistulas, and abscesses. Less commonly, they are confused with anal cancer. A misdiagnosis can lead to the wrong treatment and prolonged discomfort.

A colorectal surgeon or proctologist will typically diagnose an anal fissure by:

• Patient history, including bowel habits, pain pattern, and any bleeding.
• Visual examination: Most fissures are visible externally without an internal exam.
• Anoscopy, when needed. This is a short, painless examination that uses a small instrument to confirm the exact location of the fissure and rule out other causes, particularly for atypical or non-healing fissures.

If you notice bleeding, it's worth having it evaluated by a doctor rather than assuming it's "just a fissure," since bleeding can be a symptom of a different, sometimes more serious, condition.

How is an anal fissure treated without surgery?

Many acute (new) anal fissures heal on their own within a few weeks with simple, non-surgical measures. According to the ASCRS guidelines (2023),conservative treatment heals about half of acute fissures. Colorectal specialists typically start with:

Dietary and lifestyle changes

• Increasing fiber intake (fruits, vegetables, whole grains) to soften stools and reduce straining.
• Drinking enough fluids.
• Regular physical activity.
• Avoiding prolonged sitting on the toilet.

Topical treatments

• Nitroglycerin (nitrate) ointments: they relax the internal anal sphincter and improve blood flow to the area. Headaches are common and can be intense, and are a frequent reason for stopping treatment.
• Calcium channel blocker creams (such as diltiazem): an alternative to nitrates with a similar muscle-relaxing effect and generally fewer headaches.

Warm sitz baths

Sitting in warm water for 10-15 minutes several times a day, especially after bowel movements, helps relax the anal sphincter and eases pain.

Botox injections for anal fissure

When creams are not enough, and before considering surgery, botulinum toxin (Botox) can be injected into the internal anal sphincter. It temporarily blocks the nerve signal that keeps the sphincter contracted, for about 2-3 months, which can give the fissure time to heal. It does not require general anesthesia. Possible side effects include pain, bleeding and, temporarily, a loss of control over gas or stool.

When is surgery needed for an anal fissure?

Surgery is generally considered a later step, reserved for chronic fissures (lasting more than 6-8 weeks) that have not responded to medical treatment or Botox. Depending on your case, your colorectal surgeon may recommend one of the following:

Fissurectomy

Removal of the fissure and the surrounding scarred tissue, under local or regional anesthesia, in about 30 minutes. Most patients go home the same day. The fissure can come back.

Anoplasty

The fissure is covered with a flap of healthy tissue from the surrounding area. It is typically used for larger or more complex fissures, or after a previous treatment has not resolved the problem.

Lateral internal sphincterotomy (LIS)

According to the ASCRS guidelines (2023),it heals at least 88% of chronic fissures, more than medical treatment. The surgeon makes a small, partial incision in the internal anal sphincter, the muscle that keeps the anus closed, to relieve the pressure that prevents the fissure from healing. The sphincter is not cut through. It is performed under local or regional anesthesia and most patients go home the same day. Its main risk is a change in continence, especially for gas or loose stool (see the risks section). It is generally avoided in some situations, such as inflammatory bowel disease, and your surgeon decides after an assessment.

Comparing the surgical options

What are the risks and success rates of anal fissure surgery?

Anal fissure surgery, and lateral internal sphincterotomy in particular, is generally considered effective: the ASCRS guidelines (2023) report healing rates of at least 88% for lateral internal sphincterotomy, higher than with medical treatment. As with any procedure, it carries some risks:

• Infection at the surgical site: uncommon with proper post-operative care.
• Fecal or gas incontinence: the most specific risk of sphincterotomy, since it involves the muscle controlling continence. According to the same guidelines it can affect up to 30% of patients, temporary in some and persistent in others, and should be discussed with your surgeon beforehand, especially if you have any pre-existing bowel control concerns.
• Recurrence: possible with any treatment option.
• Delayed wound healing, more common with underlying conditions such as poorly controlled diabetes or Crohn's disease.

Your surgeon will review your specific health history to determine which option offers the best balance of effectiveness and risk for your situation.

How to care for yourself after treatment?

No matter which option you and your surgeon choose, there are a few practical steps that can support healing.

• Keep the area clean and dry. Gentle, warm sitz baths several times a day promote hygiene and comfort.
• Avoid heavy lifting and strenuous exercise for the first one to two weeks after surgery.
• Maintain a high-fiber diet, and drink plenty of water to keep stools soft and avoid straining.
• Take prescribed pain relievers and stool softeners as directed.
• Avoid prolonged sitting. Short, frequent walks support circulation and comfort.

Most patients can resume normal daily activities within a week, though full healing typically takes a few weeks, up to four to six weeks for lateral internal sphincterotomy.