Dr. Haneen AlBoosta — Consultant General, Endocrine & Laparoscopic Surgeon
Dr. Haneen AlBoosta — Consultant General, Endocrine & Laparoscopic Surgeon in Bahrain
An anal fissure is a small tear in the lining of the anal canal, typically causing sharp pain during a bowel movement that continues afterwards, often with a small amount of bright red blood. Most acute fissures heal with stool softening, fibre, sitz baths and topical medication that relaxes the anal muscle. Fissures lasting more than six to eight weeks are termed chronic and may need Botox or surgery.
For chronic fissures that have not healed with topical treatment, an injection of botulinum toxin into the internal sphincter temporarily reduces spasm and allows healing. The effect lasts a few months, which is usually enough time for the fissure to close, and it avoids permanent division of the muscle.
Lateral internal sphincterotomy divides a small portion of the internal sphincter and has high healing rates for chronic fissures resistant to other treatment. It is discussed carefully, including the small risk of altered continence, and is offered when conservative treatment and Botox have not succeeded.
No. Most fissures heal with stool softening, fibre, sitz baths and topical treatment. Surgery is reserved for chronic fissures that have not responded to those measures and Botox.
Acute fissures usually heal within four to eight weeks with consistent treatment. A fissure persisting beyond that is considered chronic and needs review.
Fissure pain is sharp and clearly linked to bowel movements, continuing afterwards, with only a little bright blood. Internal hemorrhoids more often cause painless bleeding or prolapse.
Examination is gentle and usually limited to inspection when a fissure is suspected, using local anaesthetic gel. Diagnosis can often be made without a full internal examination.
Yes, particularly if constipation and straining return. Maintaining a high-fibre diet, fluids and good bowel habits is the main preventive measure.
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Reviewed by Dr. Haneen AlBoosta, Consultant General & Endocrine Surgeon. This page is updated periodically to remain consistent with current medical references and international guidelines. It is intended for general education and does not replace an individual medical consultation, examination or treatment plan.