Advanced Fissure Surgery
An anal fissure is a cut or tear in the lining of the anus. The anus is the opening through which stool leaves the body. Tears generally occur just inside the opening.
Your doctor will likely ask about your medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible. Usually this exam is all that's needed to diagnose an anal fissure.
An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has a deeper tear, and may have internal or external fleshy growths. A fissure is considered chronic if it lasts more than eight weeks.
The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn's disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition:
Anoscopy. An anoscope is a tubular device inserted into the anus to help your doctor visualize the rectum and anus.
Flexible sigmoidoscopy. Your doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer.
Colonoscopy. Your doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea.
If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing.
Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence.