İstanbul Üniversitesi İstanbul Tıp Fakültesi Genel Cerrahi Anabilim Dalı
When treatment is initiated early, anal fissures can often be resolved without surgery. For chronic cases, lateral internal sphincterotomy offers a permanent solution.
An anal fissure is a small tear or cut in the skin or mucosa lining the inner surface of the anal canal. It manifests with severe burning and sharp pain during bowel movements, frequently accompanied by a small amount of bright red bleeding.
When symptoms have been present for less than 8 weeks, it is termed an acute fissure, whereas those lasting longer are considered chronic fissures. In chronic cases, a sentinel pile (skin tag) and sphincter hypertrophy often develop; this complicates treatment and generally makes surgery necessary.
📌 Important: Delaying bathroom visits due to pain hardens the stool and worsens the cycle. If your symptoms persist for more than 2 weeks, you should consult a surgeon.
Pain accompanied by fever, scrotal or labial swelling, and skin redness should raise suspicion for Fournier's gangrene; seek immediate emergency care.
The treatment of an anal fissure follows a step-up approach based on the duration (acute/chronic) and severity of the condition. For acute fissures, conservative management is usually sufficient; however, for chronic fissures, surgery is the standard of care.
A high-fiber diet and ample fluid intake soften the stool, reducing trauma. Warm sitz baths for 10 minutes, 2–3 times a day, relax sphincter spasms and promote healing by increasing local blood flow.
Topical anesthetics (lidocaine gel) provide short-term pain relief. Topical corticosteroids help suppress inflammation. Osmotic laxatives (lactulose, macrogol) can be added to relieve constipation.
The application of topical nitroglycerin (0.2–0.4%) or diltiazem cream chemically lowers the internal sphincter pressure, increasing the necessary blood flow for the fissure to heal. Headache is the most common side effect.
A Botulinum toxin (Botox) injection into the internal sphincter muscle induces temporary paresis; the resting anal pressure remains low for 3–6 months. During this period, the fissure heals. Compared to surgical sphincterotomy, the risk of incontinence is lower; however, the recurrence rate is higher.
In this minimal surgical procedure performed by Prof. Dr. Hakan Yanar, a small portion of the internal sphincter muscle is released using a closed technique. This lowers the resting anal pressure and increases the blood supply critical for fissure healing.
The procedure takes 20–40 minutes under spinal or local anesthesia, and patients are discharged the same day. Postoperative pain is significantly reduced, and most patients return to normal daily activities within 48 hours.
In experienced hands, the risk of incontinence is extremely low (1–2%). The long-term success rate exceeds 90%.
Prof. Dr. Hakan Yanar is an experienced general surgeon specializing in the surgical treatment of proctologic diseases at Liv Hospital Ulus. Offering a permanent solution with lateral internal sphincterotomy for chronic anal fissure cases, Prof. Yanar provides consultations in Turkish, English, French, and Russian.
Schedule a consultation with Prof. Dr. Hakan Yanar to evaluate your symptoms.
