Anal fissure is the most common cause for painful defecation (Opening bowels). Most times it is also associated with bleeding but not all the time. It is a small cut in the anal canal upto skin. Pain while passing motion which can last upto few hours afterwards is the commonest complaint. This is usually associated with Constipation (Passing hard stool/pushing hard to open bowel). At times it is seen after episode of loose motion.
***Pain while passing stool is never caused by piles/haemorroids***

The easiest way to understand is if you sustain a small cut while cutting vegetables, pain will persist until the cut has healed. The pain gets aggravated whenever anything touches the wound, including clothes. Similarly, the pain gets stimulated when the stool passes through the anal canal touching the fissure.

When treated appropriately in the initial stages, fissure heals upto 75% with medicines. Longer the duration less likely it is to heal with creams and might need simple surgery to relax the sphincters so that fissure can heal.

• Main stay of treatment includes keeping stools soft. This is usually achieved by laxatives during the period of anal fissure but in the long run by eating more fruits and vegetables, drinking at-least three lts of water in a day and exercise.

• Local anaesthetic cream applied 20 mins before passing the motion will help in relieving the pain.

• Second cream (2% Diltigesic) helps to relax the muscle which helps in the healing of the fissure. With this treatment usually 50-60% of fissures heal.

Next step should be injection into sphincters if patients are affordable. This will increase the chances of healing upto 75-80%. This is more so recommended in females as they have weak and small sphincters compared to men and more over they can also be damaged at the time of vaginal delivery. The injection causes only temporary relaxation of muscles (upto 6 months) so that fissure can heal.

Other wise in patients in whom fissure does not heal by conservative management simple Laser fissure Treatment/Laser fissure surgery is required (LATERAL SPHNCTEROTOMY) . Laser fissure Treatment/Laser fissure surgery will reduce the pain significantly within 24 hrs.

Laser fissure Treatment/Laser fissure surgery has now revolutionised treatment of Anal Fissure. One can have LASER Lateral Sphincterotomy ( Laser fissure Treatment/Laser fissure surgery) with minimal incision, Less pain and quicker recovery. Wound from Laser fissure Treatment/Laser fissure surgery is hardly visible.

Any anal fissure that has not healed even after 6 weeks is called chronic anal fissure. Conservative measures are unlikely to work, and patients might need Laser fissure Treatment/Laser fissure surgery most of the times.

A small skin tag (sentinel skin tag) can develop in chronic fissures. Some patients may experience itching. Fissure will never lead to cancer.