Patient guide
A fissure can cause sharp pain that feels completely out of proportion for such a small tear, and it tends to catch people off guard. Most settle down with simple measures, and laser treatment is there for the ones that don't.
This page is general information from Dr. Jose John Maliakal, not a diagnosis. Your treatment plan is decided together at consultation.
What people usually notice
- Sharp, cutting pain when you pass stool, that can linger for hours afterward
- A small tear or crack you can see at the opening of the anus
- Bright red blood on the stool or on the toilet tissue
- A spasm-like pain or burning feeling after you've been to the toilet
- A small skin tag near the fissure, sometimes called a sentinel pile
- Putting off going to the toilet because you're dreading the pain
When I would want you seen sooner
- Heavy or persistent bleeding needs prompt attention
- Pain that stays severe and doesn't ease up between bowel movements should not be ignored
- Fever, or pus and foul-smelling discharge, can mean infection. Please get checked
- If things aren't improving despite several weeks of conservative care, come back in and let me take another look
With any of these, go to the nearest emergency department. Don’t wait for an OPD slot.
Your options
Conservative (medical) management
Many fissures, especially recent ones, settle down with fibre, plenty of fluids, stool softeners, and topical medication that relaxes the muscle and improves local blood flow. This is usually what I try first, where it's appropriate.
Laser treatment for fissure
often day careLaser sphincterotomy
For fissures that don't settle with conservative care, or that have become long-standing, a laser procedure can help the area heal, usually through a small opening rather than an open cut.
After the procedure
Everyone is a little different, and I will confirm your own plan when I see you. Broadly, this is what to expect.
Day of procedure / start of treatment
If we manage things conservatively, I'll give you a plan for creams, fibre, and fluids. If a procedure is needed, it's often day care or a short stay, which I'll confirm at your consultation.
First few days
Discomfort when you pass stool is common at first. Warm sitz baths and the medication I prescribe help with this. Keeping your stools soft matters throughout.
1 to 2 weeks
Most people notice the pain gradually easing as the area heals.
4 to 6 weeks
Complete healing of the tissue can take this long, sometimes a little more. I'll check your progress and confirm once it's fully settled.
Good to know
Will I definitely need surgery for a fissure?
No. Many fissures heal with fibre, fluids, and medication, particularly if we catch them early. I consider laser treatment when the fissure is long-standing or isn't responding to conservative care.
Does laser treatment for fissures hurt?
There is some discomfort involved, as with any procedure, and I manage that with pain relief. I'll walk you through exactly what to expect for your particular case.
Why do fissures keep coming back?
Fissures are strongly linked to constipation and straining. Sorting out your bowel habits, fibre intake, and hydration lowers the chance of it happening again, though nothing can guarantee it won't.
How soon can I get back to normal activity?
Most people can go about their daily activities within a few days. A full return to comfortable, pain-free bowel movements takes a bit longer and varies from person to person.
Could this be something more serious than a fissure?
Persistent anal pain and bleeding should always be examined properly rather than assumed to be a simple fissure, particularly if it's new or unusual for you. This page is general information, not a diagnosis.
Let us have a chat
If you are worried about a symptom, thinking about treatment, or you just want a clearer answer, send me a WhatsApp message and we will help you arrange a time at Thangam Hospital.
Thangam Hospital of PMRC
West Yakkara, Palakkad, Kerala 678004
OPD 9:00 AM – 4:00 PM
Please confirm the day’s OPD on WhatsApp before travelling.
After you message, we will confirm the day's OPD, help you pick a time, and tell you what to bring: any earlier reports and scans, your current medicines, and your insurance card if you have one. Please avoid sending sensitive medical reports on WhatsApp unless we ask you to.