Anal Fissure Treatment - Diagnosis, Surgery and Recovery

Surgical Treatment Options for Fissure

There are two types of anal fissure surgery i.e. open anal fissure surgery or laser anal fissure surgery.

Open anal fissure surgery

1. During the procedure, you will be sedated under general anesthesia to ensure a pain-free experience. The surgeon will then position you in a suitable manner to access the affected area with ease.
2. Next, an incision will be made around the anus to reach the anal fissure. The surgeon will thoroughly assess the fissure’s extent of damage and check for any additional issues.
3. Any damaged tissue surrounding the anal fissure will be carefully removed to facilitate proper healing. Following this, the area will be sutured to close the incision.
4. After the procedure, you will be closely monitored to ensure there are no complications, and any post-operative pain or discomfort will be effectively managed.

Laser anal fissure surgery

1. First, you will be positioned on your back with your knees bent and legs apart.
2. The doctor will administer medication to numb the area or put you to sleep to ensure a pain-free procedure.
3. Once you are prepared, the surgeon will use a laser through the natural opening of the anus to reach the location of the small tear (fissure).
4. By using the laser, the surgeon will carefully make a cut in the muscles around the anus to promote relaxation.
5. After the surgery, you will be moved to a recovery room where you can rest and recover.

Best Treatment Option for Anal Fissure

Laser fissure surgery is considered the best treatment option for anal fissures. This minimally invasive procedure offers several advantages over traditional surgical methods. Laser technology allows for precise and targeted treatment, resulting in minimal damage to surrounding tissues.

The procedure is typically performed on an outpatient basis, which means no hospitalization is required after this surgery. Laser fissure surgery also promotes faster healing and recovery, with reduced post-operative pain and discomfort.

Additionally, the risk of complications, such as infection, is significantly minimized with this advanced surgical technique. Overall, laser fissure surgery offers a safe and effective solution for anal fissures, making it the preferred treatment option for many patients.

Candidates for Laser Fissure Surgery

• Patients with chronic anal fissures that have not responded to conservative treatments.
• Individuals with severe pain and discomfort during bowel movements.
• Patients with recurrent anal fissures despite previous surgical interventions.
• Patients experiencing persistent bleeding from anal fissures.
• Patients who have tried topical medications and dietary changes without success.
• Individuals with underlying medical conditions, such as Crohn’s disease or inflammatory bowel disease, contribute to chronic anal fissures.
• Patients who desire a minimally invasive surgical option for the treatment of anal fissures.
• Patients prefer a shorter recovery time compared to traditional surgical procedures.
• Patients who want to avoid the potential complications associated with traditional surgical techniques.
• Patients who are seeking a long-term solution for anal fissures.

The final decision to finalize the candidate for laser fissure surgery totally depends on the proctologist according to the individual’s overall health and the severity of the condition.

Benefits of Laser Anal Fissure Surgery

Laser anal fissure surgery offers various benefits over other traditional surgical methods. Some benefits of laser anal fissure surgery are:

• Minimally Invasive: Laser anal fissure surgery is a minimally invasive procedure involving the use of a laser beam to treat the fissure. This leads to no incisions, less pain, and faster recovery.

• Improved Healing: Laser technology promotes better healing by sealing the blood vessels and nerve endings, reducing inflammation, and stimulating the growth of healthy tissues. This helps to prevent complications and speed up the recovery process.

• Reduced Risk of Infection: The use of laser technology in anal fissure surgery significantly reduces the risk of infection. Laser anal fissure surgery minimizes the chances of bacterial contamination and ensures a safer surgical experience.

• Precise and Accurate: Laser anal fissure surgery allows for precise and accurate treatment. The laser beam can target the specific area of the fissure, minimizing damage to surrounding tissues and ensuring optimal results.

• Less Postoperative Pain: Compared to traditional surgical methods, laser anal fissure surgery results in less postoperative pain. The laser beam cauterizes nerve endings, reducing pain signals and providing patients with a more comfortable recovery.

• Reduced Bleeding: Laser technology effectively seals blood vessels during the surgical procedure, resulting in reduced bleeding. This helps to minimize the risk of excessive bleeding during and after surgery, leading to a quicker recovery.

• Shorter Hospital Stay: Due to the minimally invasive nature of laser anal fissure surgery and the reduced risk of complications, patients typically have shorter hospital stays. This allows for a quicker return to normal activities and daily routines.

• High Success Rate: Laser anal fissure surgery has shown a high success rate in treating anal fissures compared to other surgeries. The precise and effective nature of the procedure, along with improved healing, results in long-term relief for patients.

Preparation Tips for Laser Fissure Surgery

Here are some general preparation tips to help you prepare for your surgery:

• Consult with your surgeon to discuss the procedure and address any concerns.
• Follow any pre-surgical instructions provided by your healthcare provider.
• Inform your surgeon about any medications you are currently taking.
• Arrange for someone to accompany you on the day of the surgery.
• Fast as instructed before the surgery to ensure an empty stomach.
• Shower and wash the surgical area with antibacterial soap the night before or on the day of the surgery.
• Avoid applying any creams, lotions, or oils to the surgical area prior to the procedure.
• Wear loose and comfortable clothing on the day of the surgery.
• Bring all necessary documents, including ID, insurance information, and any presurgical test results.
• Follow any additional instructions provided by your surgeon for a successful surgery.

It is important to follow these preparation tips to ensure a smooth and successful laser fissure surgery.

Recovery Tips After Laser Fissure Surgery

Here are some common recovery tips that you should follow to ensure a safe and fast recovery after laser fissure surgery:

• Take prescribed pain medications as directed.
• Apply ice packs to the surgical area to reduce swelling.
• Keep the surgical area clean and dry.
• Use a sitz bath to help soothe the area.
• Avoid straining during bowel movements.
• Consume a high-fiber diet to prevent constipation.
• Stay hydrated by drinking plenty of water.
• Avoid spicy and acidic foods that may irritate the surgical area.
• Take short walks to promote blood circulation.
• Avoid sitting for prolonged periods of time.
• Use a cushion or pillow to sit on for added comfort.
• Follow the post-operative care instructions provided by your surgeon.
• Avoid heavy lifting or strenuous activities.
• Take rest and get adequate sleep to aid in the healing process.
• Contact your doctor if you experience excessive bleeding, severe pain, or signs of infection.

Risks and Complications Associated with Laser Anal Fissure Surgery

Like every surgical treatment, laser anal fissure surgery also has some risks and complications, such as:

• Infection at the surgical site
• Bleeding during or after the procedure
• Scarring or tissue damage
• Pain or discomfort during the recovery period
• Difficulty in passing stools or temporary fecal incontinence
• Allergic reactions to anesthesia or medications used during surgery
• Development of an anal fistula
• Recurrence of the fissure
• Changes in bowel movements or constipation
• Adverse reactions to pain medications prescribed post-surgery
• Rare complications such as nerve damage or rectal perforation

Non-surgical Treatment Options for Anal Fissure

Anal fissure symptoms can be managed at home by non-surgical treatments if it is diagnosed in their initial stage. Here are some non surgical treatment options:

Home Remedies

• Apply aloe vera gel or petroleum jelly to soothe and moisturize the anal area.
• Sit in warm water for 10-15 minutes a few times a day to reduce pain and discomfort.
• Use a cold compress to reduce swelling and inflammation.
• Drink plenty of water or juices to keep yourself hydrated, and eat fiber-rich foods to keep your digestive system healthy and prevent constipation.
• Apply coconut oil to the affected area for relief.
• Use petroleum jelly to lubricate the anus and reduce friction during bowel movements.
• Apply witch hazel to the affected area to reduce pain and itching.

Medicines

Here are some ointments and medications commonly used for treating anal fissures:

• Ointments

1. Shield Rectal Ointment: This effective ointment contains allantoin, lidocaine, hydrocortisone acetate, and zinc oxide. It provides relief from pain and discomfort associated with fissures. Apply it 2-3 times daily. It costs INR 73 for 15g.

1. Doctor Butler’s Fissure Ointment: Available over-the-counter, this ointment offers immediate relief from anal burning and discomfort. It combines medical and herbal ingredients.

1. Anovate Cream: Anovate cream is designed to alleviate pain and discomfort caused by anal fissures. Its ingredients include beclomethasone, lidocaine/lignocaine, and phenylephrine.

1. Lignocaine Gel for Fissure: Lignocaine, a common topical anesthetic for anal fissures, is found in this gel. It contains Alcuronium, Amphotericin B, Amprenavir, among others.

• Medications

1. Lidocaine is a frequently prescribed topical anesthetic for anal fissures.
2. For chronic anal fissure treatment, doctors often use topical nitroglycerin to relax the anal muscles.

Lifestyle Modifications

• Avoid using harsh soaps, perfumes, or scented products near the anal area, as they can cause irritation.
• Consider using a donut-shaped cushion to relieve pressure on the affected area when sitting.
• Practice good toilet habits by not straining during bowel movements and avoiding excessive wiping.
• Avoid sitting for prolonged periods and take breaks to walk around and improve blood circulation.
• Avoid spicy and greasy foods, as they can aggravate symptoms.
• Apply a warm compress to the affected area for 10-15 minutes, several times a day.
• Keep the anal area clean by gently washing with mild soap and water after each bowel movement.
• Use moist wipes or a bidet instead of dry toilet paper to avoid further irritation.
• Apply over-the-counter hemorrhoid creams or ointments to reduce pain and inflammation.

Cost of Laser Anal Fissure Surgery

The cost of laser anal fissure surgery may lie anywhere between INR 35,000 to INR 50,000 in India. The final cost of the laser anal fissure surgery may vary for each individual depending on various factors such as:

• Hospitalization charges
• Surgeon’s fee
• Location of the hospital
• The severity of the condition
• Insurance coverage
• Cost of diagnostic tests
• Age and health of the patient

Is the fissure surgery covered under health insurance?

All major health insurance plans generally include coverage for surgical procedures, including laser surgery for anal fissures. However, the specifics of coverage can vary greatly based on your individual insurance policy, such as the amount of the deductible, copay, or coinsurance.

There may also be certain conditions or prerequisites for coverage, like a referral from a primary care physician or pre-authorization for the procedure. Some policies may cover only a part of the cost, while others may cover it entirely.

Therefore, it is essential to communicate with your healthcare provider and your insurance company to understand the details of your coverage. They can give you a clearer understanding of any out-of-pocket costs you might need to pay, and guide you on how to get the necessary approvals for the surgery, if required.

Here’s a list of some health insurance companies that usually cover the cost of anal fissure surgery.

• Niva Bupa health insurance
• Star health insurance
• Aditya birla health insurance
• Max bupa health insurance
• And many more