Anal Fissure Surgery: Help for Chronic Anal Fissures—When Surgery Is Recommended

Common causes of an anal fissure include

• stool that is too hard,
• diarrhea,
• hemorrhoids,
• inflammation of the rectum, and
• anal intercourse.

Those affected often avoid seeing a doctor out of a false sense of shame. In doing so, they risk the symptoms becoming chronic.

Due to the pain, people sometimes hold back from having a bowel movement. Constipation is therefore a possible secondary symptom of an anal fissure.

Symptoms of an anal fissure include pain during bowel movements, a burning or stinging sensation in the anus, and a bright red streak of blood on the toilet paper. Many patients develop a reflexive spasm of the sphincter muscle due to the fissure, which can further intensify severe pain in the anus. In the case of a chronic anal fissure, an outpost fold, anal papilla, or wound discharge may also occur. If symptoms persist for longer than six weeks, the condition has often already progressed to a chronic form with scarred tissue, which makes wound healing more difficult.

Before surgery is performed, conservative treatment of the anal fissure is attempted first, for example with ointments. However, surgery is the treatment of choice for chronic fissures, especially when symptoms impair quality of life.

Key measures include medications to regulate bowel movements—to prevent hard stools or excessive straining—as well as the application of ointments, especially during the acute stages of an anal fissure. If the ointment does not lead to healing or if additional factors worsen the condition, an acute anal fissure can quickly develop into a chronic one. The wound heals more slowly due to reduced blood flow, which further delays the healing process.

Anal fissure surgery is a minor surgical procedure in the field of proctosurgery or surgical proctology and is typically performed on an outpatient basis; general anesthesia is not required. During the procedure, the surgeon removes the fissure along with the scar tissue as part of a fissurectomy. An open wound remains. Healing after this traditional surgical method usually takes 4 to 6 weeks and, with consistent follow-up care, generally proceeds without complications.

Alternatively, surgery for anal fissures can also be performed by partially cutting the internal sphincter (sphincterotomy). Relieving pressure on the sphincter reduces pressure, which improves healing of the fissure and often yields good results in chronic cases. However, this technique carries a risk of subsequent fecal incontinence, as the internal sphincter can lose tone with age, and symptoms may recur even decades after anal fissure surgery. 

In some cases, the surgery can also be performed using a laser procedure. This method allows the surgeon to remove the affected tissue structures with exceptional precision, thereby shortening the healing time. The laser light reduces bleeding, and the fissure can be treated with great precision.

The goal of these surgeries is to completely remove the fissure, relieve pressure on the sphincter muscle, and thereby create conditions under which the fissure can reliably begin to heal.

As with almost any surgery, bleeding and postoperative bleeding can occur after anal fissure surgery. Patients often find these symptoms distressing. Wound healing complications may also arise, delaying complete healing or causing additional pain. In rare cases, significant scarring may also occur, especially if scarred tissue or a chronic condition was already present before surgery.

For the diagnosis and treatment of anal fissures and other diseases of the rectum,

• proctologists or
• gastroenterologists

are the appropriate specialists to consult.

To ensure that the wound heals as smoothly as possible, careful anal hygiene after the procedure is crucial. Sitz baths have a disinfecting effect, support wound care, and can promote the healing of the anal fissure and relieve pain. Soft stools resulting from a high-fiber diet can also help.

Depending on the severity of the fissure, the surgical procedure used, and the patient’s cooperation, wound healing can take several weeks.

With traditional surgery, the healing period is 4 to 6 weeks, although consistent follow-up care significantly improves the outcome.
During this phase, taking pain relievers, the continued use of a doctor-prescribed ointment, and regular follow-up visits can help ensure that the recovery proceeds with few complications and that symptoms subside quickly.