Anal Fissure

Diet, topical therapy, Botox, and LIS

Most acute fissures heal without cutting the sphincter — chronic fissures need a stepwise plan.

An anal fissure is a tear in the anoderm that causes severe pain with bowel movements, often with bright red blood on the paper. Acute fissures frequently heal with soft stools, fiber, fluids, and topical agents that reduce sphincter spasm. Chronic fissures may need Botox (chemical sphincterotomy concept) or, in selected failures, lateral internal sphincterotomy (LIS). Continence risk is discussed before any sphincter-dividing surgery. Crohn’s disease and infection can mimic fissures — the diagnosis should be confirmed, not assumed forever as “constipation tear.”