A fissure is a small tear in the anal canal , canoe shaped, and measuring about an eighth of one-inch, very much like a split lip. They are caused by constipation. Fissures are common and almost all heal immediately with anal care such as stool softeners and cottonelle baby wipes.
Occasionally the fissure fails to heal due to continued spasm of the internal sphincter muscle cutting off it’s blood supply. The fissure now develops into a chronic ulcer which causes severe pain and often bleeding during and after bowel movements. The pain may last for hours.
Chronic fissures may heal for months and then break open again. Most are in the posterior anus, that is towards the tail bone.
Treatment requires a small nick in the internal sphincter muscle in order to relax it, called a sphincterotomy. This muscle relaxation allows the fissure to heal after vaporization of the scar tissue surrounding it using the wide beam of the laser.
The procedure is done in our outpatient facility, under twilight sleep and long acting local anesthesia. Patients are given antibiotics to prevent infection.
Recovery is almost immediate and recurrence is rare.
Post operative discomfort is managed with warm baths, alternating with ice packs to the area.
Complications are rare. Infection is prevented by post operative antibiotics. Because we use such a small incision in the sphincter muscle, it heals without loss of function.