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Is Surgery A Necessity For Treating Anal Fissures?

What are Anal Fissures?

Anal Fissure occurs when there is a tear in the small anal mucosa.(3) This normally happens when an individual passes large hard stools. It is the hardness of the stools that causes the tear, as it passes through the anus.(4) People who suffer from chronic constipation get hard stools resulting in a tear, severe pain and even at times bleeding from the area while passing bowels.(4) Spasms of the muscles of the anal sphincter are also seen with anal fissures.[1]

Anal Fissure is quite a common and benign condition and causes no harm to the body.(3) Anal Fissures are mostly seen in infants even though people of any age can get it.(5) Half of the cases of anal fissures get cured by following simple home treatments and lifestyle changes like increasing fiber and fluid intake to make the stools soft and hasten the healing process.[1]

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However, if these measures are ineffective, then medical management or even at times surgery may be needed to treat anal fissure. A diagnosis generally is made of anal fissures just by doing a physical examination and taking the patient’s history. In rare cases, further tests may be needed to confirm the diagnosis of anal fissures.[1]

Anal fissures are basically of two types, primary and secondary. While primary anal fissure is common and is benign; secondary anal fissures are not so common and are quite serious requiring medical intervention. This article informs as to whether surgery is a necessity to treat anal fissures or not.[1]

Is Surgery a Necessity for Treating Anal Fissures?

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The answer to this question is NO. It is not always necessary to perform surgery to treat anal fissures.(6,7) However, in some cases where the condition becomes chronic with frequent recurrences and severe symptoms, then it is best to move forward with surgery to get rid of the condition once and for all. The primary aim of the surgery to treat anal fissures is to relax the muscles of the anal sphincter and help relieve pain. This further promotes healing and hastens the recovery process.[2]

The noninvasive procedures for treating anal fissures include Botox injection in the anal sphincter.(8) This helps to relax the muscles of the anal sphincter and calm down the symptoms of anal fissures, although this form of treatment may not be permanent and the chances of recurrence are quite high.[1]

Internal sphincterotomy is perhaps the most preferred procedure for treatment of anal fissures.(9) This procedure involves resecting a part of the muscle of the anal sphincter to relax the anal sphincter and relieve the pain caused due to anal fissures. This procedure has proved to be extremely effective and gives almost a permanent relief from the symptoms of anal fissures with very little incidences of recurrence.[1]

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It normally takes a couple of days for the patient to return back to normal life after the more invasive internal sphincterotomy. However, it normally takes anywhere between 8-10 weeks post treatment for complete relief of symptoms of anal fissures. Postsurgery, it is recommended that the patient eats a high fiber diet and avoid foods that are difficult to digest, as it may result in constipation and hard stools, which may again cause a tear of the anal mucosa.[1]

Studies estimate that while Botox injections are effective in treating anal fissures with up to 50% people having complete healing. Sphincterotomy on the other hand has resulted in complete healing of anal fissures in over 90% of the cases even though in some instances this procedure has caused difficulty in controlling bowel movements even if it is rare.[1]

The recurrence rate of anal fissures is quite high as any trauma or passing of hard stool can result in a tear causing the symptoms of this condition. Thus dietary modifications, which include plenty of fiber, avoiding fatty foods, and drinking plenty of fluids, are a must to prevent a condition like anal fissures.[1]

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