It’s a question many people dealing with this painful issue are asking.Anal fissures which are basically little tears in the skin around your anus, are, unfortunately, quite common.They can cause a lot of discomfort, so it’s natural to wonder if surgery is the only way out.We’ll dig into whether surgery is truly necessary, exploring the non-surgical options that are often effective and when if ever surgery might become a reasonable choice.

What exactly are anal fissures?

Well, think of them as small cracks or tears in the skin near the anus. They’re frequently caused by trauma like passing hard stools, having diarrhea, or even just wiping too vigorously. The symptoms can be pretty unpleasant. You might experience sharp pain during or after a bowel movement. There’s often bleeding usually bright red on the toilet paper or in the stool. Itching and irritation around the anus are common too. Sometimes, you can even see the tear or crack. The good news is that a lot of fissures heal on their own within a few weeks particularly if you’re taking good care of things. However some become chronic, lasting longer than six weeks, or they may keep coming back, which then warrants more involved treatment.

Is surgery always necessary?

The short answer is no it’s really not.Actually, the majority of anal fissures can be managed and healed with more conservative non-surgical treatments.Surgery is generally considered when those other treatments haven’t worked or in cases of chronic or especially severe fissures that don’t respond to anything else. Let’s explore those non-surgical options in more detail.

Firstly, let’s talk about diet and hydration.This is often the first and most effective step in treatment.It helps soften your stools and reduces the strain during bowel movements, which is a huge factor in causing fissures in the first place.

What should you do?

• Increase your fiber intake.Think fruits, veggies, whole grains and legumes.It’s all about making your stools easier to pass.
• Drink plenty of water too; staying well-hydrated keeps your stools moist.You could also consider fiber supplements if you’re not getting enough fiber from your food.Something like psyllium husk (Metamucil) could be helpful.
• Then there are topical treatments.These can be either over-the-counter or prescription and they aim to relieve pain and encourage healing They typically work by relaxing the anal sphincter muscle.This can reduce pain and by increasing blood flow to the area it gives the fissure a better chance to heal.Some common options here include topical nitroglycerin which relaxes the internal anal sphincter. It reduces pressure and improves blood flow.However, it can cause side effects like headaches.
• Calcium channel blockers like nifedipine, are another option, with a similar effect and often fewer side effects.
• Hydrocortisone creams can help reduce inflammation and itching, making things a little more comfortable.Another effective treatment: warm sitz baths.Just sit in warm water for maybe 10 to 20 minutes a few times a day, especially after bowel movements.The warm water helps to relax the anal sphincter which reduces pain and aids healing.It improves blood flow to the area and cleanses the area, reducing the risk of infection.
• Stool softeners are often recommended too, such as docusate sodium (Colace). They help prevent straining during bowel movements.
• Straining is a big culprit in causing anal fissures, so keeping the stool soft can really make a difference.Your doctor might suggest these as part of your treatment, especially if you’re dealing with chronic constipation.

• Avoid straining during bowel movements.Seems obvious, right? But here are some tips.Go when you feel the urge; don’t wait too long.
• Try using a footstool to elevate your feet when you’re on the toilet helping with alignment.Also don’t rush.Take your time and relax.
• Finally for pain relief, over-the-counter pain relievers like ibuprofen or acetaminophen can help.You can also use topical anesthetic creams.But remember pain relief alone isn’t enough; it really needs to be combined with other treatments.

When might surgery become necessary?

Well despite the non-surgical options, sometimes it just isn’t enough.Surgery is generally considered in the following cases.If a fissure doesn’t heal within six to eight weeks despite treatment, it’s considered chronic.

Chronic fissures can get scarred and be more difficult to heal. Surgery is sometimes needed to get things moving.If the internal anal sphincter muscle is in constant spasm due to a fissure, this can create a cycle of pain and delayed healing.

Botulinum toxin injections (Botox) or surgery might be considered to relax the muscle.Sometimes fissures are associated with other conditions, like Crohn’s disease or ulcerative colitis, which can complicate healing. In those cases surgery might become a necessity.Of course, if conservative treatments just don’t work – the topical medications, dietary changes and stool softeners – surgery may be needed.

What are the surgical options?

• Lateral internal sphincterotomy is the most common, involving a small incision in the internal anal sphincter.
• A fissurectomy is another option, removing the scar tissue.
• Botox injections can also be used but these aren’t always permanent.In conclusion surgery isn’t always the answer.

Non-surgical treatments are often enough to heal things. If your fissure does become chronic or if the other treatments don’t help, surgery is available. If you’re dealing with the pain of an anal fissure, start with the non-surgical methods.If things persist, it’s always wise to chat with your doctor.With the proper care most anal fissures can be treated effectively and you’ll get back to your normal life.