SYMPTOMS, DIAGNOSTICS & TREATMENT OF
Anal Fissures
SYMPTOMS, DIAGNOSTICS & TREATMENT OF
Anal Fissures
Private Anal Fissures Diagnosis & Surgery
Mr Peter Asaad provides specialist anal fissure treatment for patients across the North West. He offers expert assessment, diagnosis and treatment for acute and chronic anal fissures, including non-surgical management and anal fissure surgery, helping to relieve pain, promote healing and reduce the risk of recurrence.
Condition
What is an Anal Fissure?
An anal fissure is a small tear in the lining of the anal canal, most commonly towards the back of the anus. Although the tear is usually only a few millimetres long, it can cause severe pain because the area contains a large number of sensitive nerve endings.
Anal fissures are a common condition and can affect people of all ages. They most often develop after passing a large or hard stool, but they can also occur following diarrhoea, childbirth or repeated straining during bowel movements.
If an anal fissure does not heal within a few weeks, it may become chronic. Chronic fissures are less likely to heal on their own and may develop thickened edges and a small external skin tag, known as a sentinel skin tag. This is simply a sign that the fissure has been present for some time.
Many people mistake an anal fissure for haemorrhoids (piles) because both conditions can cause pain and bright red bleeding after opening the bowels. However, they are different conditions and require different treatments, making an accurate diagnosis important.
The good news is that, in most cases, anal fissures can be treated without surgery using simple measures such as dietary changes, stool softeners and prescription creams. If symptoms persist or the fissure becomes chronic, specialist assessment is recommended. A range of effective treatments are available, including both non-surgical and surgical options, depending on your individual circumstances.
Symptoms
Anal Fissure Symptoms
Anal fissures typically cause symptoms around the anus, particularly during and after opening the bowels. Symptoms can range from mild discomfort to severe pain and, if left untreated, may persist or the fissure can become chronic.
COMMON SYMPTOMS INCLUDE:
- Sharp pain
- Bright red bleeding
- Burning sensation
- Itching
- Small skin tag
- Fear of opening the bowels
Causes
Causes of Anal Fissures
Anal fissures usually develop when the lining of the anal canal is stretched or injured. This is most commonly caused by constipation, but there are several other recognised causes.
Common causes include:
- Constipation
- Diarrhoea
- Childbirth
- Straining
- Anal intercourse
- Previous anal surgery
- Inflammatory bowel disease (e.g. Crohn's disease)
Diagnostics
Anal Fissure Diagnosis
Most anal fissures can be diagnosed during a consultation with a colorectal surgeon. During your consultation we will cover the following:
Your appointment will begin with a discussion about your symptoms, including when they started, what makes them worse and whether you have noticed any bleeding or changes in your bowel habit.
An examination of the anal area is often all that is needed to confirm the diagnosis of anal fissure. In many cases, the anal fissure can be seen without the need for an internal examination.
If your symptoms are severe, recurrent or the diagnosis is unclear, further investigations may occasionally be recommended. These may include a flexible sigmoidoscopy or colonoscopy to exclude other conditions
Private Diagnosis Pathway
Mr Peter Asaad is a Consultant General and Colorectal Surgeon with over 17 years’ experience in the NHS.Â
A typical private diagnosis of an Anal Fissure under his care involves:
- Initial consultation
- Careful examination
- Scans arranged
- Rapid review of results
- Personalised Treatment Plan
Once a diagnosis has been confirmed, your treatment options will be discussed in detail. Most anal fissures can be treated without surgery, while chronic or persistent fissures may benefit from more specialised treatments, such as Botox® injection or surgery.
Anal Fissure Treatment Options
Most anal fissures heal without surgery. The aim of treatment is to reduce pain, prevent further injury to the fissure and create the best possible conditions for healing.
Non-surgical treatments include:
- Increasing fibre intakeÂ
- Drinking plenty of fluidsÂ
- Avoiding constipationÂ
- Stool softeners or laxativesÂ
- Pain reliefÂ
- Warm baths (sitz baths)Â
- Prescription creams
If symptoms persist despite these measures, further treatment may be recommended. This will depend on whether the fissure has become chronic and your individual circumstances.
When is surgery recommended for anal fissures?
Most anal fissures heal with simple non-surgical treatments. However, if the fissure fails to heal and becomes chronic, the underlying muscle can remain in spasm, reducing blood flow to the area and preventing healing. In these circumstances, further intervention may be recommended.
Depending on your individual circumstances, this may include Botox® injection into the anal sphincter or surgery. The most appropriate treatment will depend on your symptoms, examination findings and previous treatments, and will be discussed with you during your consultation.
DISCUSS TREATMENT OPTIONS TODAY
Read more about what to expect during anal fissure surgery below or get in contact with Mr Peter Asaad today.
Treatment
Anal Fissure Surgery
What to expect during Anal Fissure Surgery
If Botox® injection or surgery is recommended, your procedure is usually performed as a day case under a general anaesthetic, allowing you to return home the same day.
Before your procedure, you will receive clear instructions about when to stop eating and drinking, which medications you should continue or temporarily stop, and what to expect on the day of surgery.
The planned procedure will have been discussed with you during your consultation and will depend on the nature of your fissure. This may involve Botox® injection into the anal sphincter or a lateral internal sphincterotomy. Your surgeon will explain the benefits, risks and expected recovery before asking for your consent.
Recovery after Anal Fissure Surgery
Recovery varies depending on the procedure performed, but most patients recover well and gradually return to their normal activities over the following weeks. It is important to remember that treatment is designed to create the conditions for the fissure to heal, and improvement is often gradual rather than immediate.
Botox® injection recovery
- Botox® usually takes around 2 weeks to take full effectÂ
- As the anal sphincter gradually relaxes, blood flow improves and the fissure begins to healÂ
- Symptoms often improve gradually over the following weeks rather than immediately after treatmentÂ
- Following Botox®, many patients can return to work within a few days
Lateral internal sphincterotomy recovery
- Pain often improves sooner than with Botox®, although complete symptom relief is not always immediateÂ
- Healing continues over the following weeks as the fissure recoversÂ
- Following a lateral internal sphincterotomy, around 2 weeks off work is often recommended, depending on your recovery and the type of work you doÂ
Day of surgery
- Return home the same day
- Mild discomfort is expected
- Regular pain relief will be provided
First few days
- Continue pain relief as required
- Eat a high-fibre diet and drink plenty of fluids
- Laxatives may be recommended to help avoid constipation
Exercise
- Gentle walking is encouraged from the day of surgery
- Avoid heavy lifting and strenuous exercise until advised otherwise
Diet After Surgery
- Maintain high-fibre diet
- Drink plenty fluids
Costs of Private Anal Fissure Surgery
The cost of private anal fissure surgery can vary depending on the type of anal fissure surgery treatment and will be discussed with you during the consultation.
Using private medical insurance
If you have private medical insurance, treatment is often covered.
I am recognised by major UK insurers, including:
- BUPA
- WPA
- Aviva
- AXA
- Vitality
- Healix
- Cigna
You will usually require:
- A referral from your GPÂ
- Pre-authorisation from your insurerÂ
It is advisable to check directly with your insurer to confirm your level of cover.
Self-pay patients
For patients funding their own treatment, costs are typically provided as a package price by the hospital.
This usually includes:
- Hospital feesÂ
- Theatre and nursing costsÂ
- Anaesthetist feesÂ
- Surgeon fees
- Standard aftercareÂ
Pricing can vary between hospitals, so the most accurate way to obtain a quote is to contact the hospital directly, where a tailored estimate can be provided.
Payment options
Some hospitals offer flexible payment plans, allowing costs to be spread over time.
These options can change, so it is best to check directly with the hospital for the most up-to-date information.
About
Mr Peter Asaad
Mr Peter Asaad is a Consultant General and Colorectal Surgeon with over 17 years’ experience in the NHS.
He specialises in colorectal surgery and the treatment of bowel conditions, alongside common general surgical problems such as hernias and gallstones. His practice includes advanced keyhole techniques for colorectal cancer and the management of conditions such as haemorrhoids, fissures and fistulas.
He sees patients within Wrightington, Wigan and Leigh NHS Trust and privately across Manchester and Cheshire.
Mr Asaad provides clear, pragmatic advice and a straightforward approach to treatment, ensuring patients understand their options and can proceed with confidence.
testimonials
What Patients Say
Frequently Asked Questions
These are some of the most common questions patients ask about anal fistulas and surgery. As new questions arise, this section will be updated to provide clear and relevant information.
What is an anal fissure?
An anal fissure is a small tear in the lining of the anal canal. Although the tear is usually small, it can cause significant pain because the area contains many sensitive nerve endings.
What are the symptoms of an anal fissure?
The most common symptoms are sharp pain during or after opening the bowels, bright red bleeding, burning, itching and discomfort around the anus. Some people also develop a small skin tag if the fissure becomes chronic.
What causes an anal fissure?
Anal fissures are most commonly caused by constipation. Other causes include diarrhoea, childbirth, straining, anal intercourse and inflammatory bowel disease such as Crohn’s disease.
Will an anal fissure heal on its own?
Many acute anal fissures heal without surgery if constipation is treated and the area is allowed to heal. If symptoms persist for several weeks, specialist assessment is recommended.
How long does it take for an anal fissure to heal?
Many acute anal fissures heal within a few weeks with appropriate treatment. Chronic fissures often take longer and may require specialist treatment to promote healing.
How do you treat an anal fissure?
Most anal fissures heal with simple treatments such as increasing fibre intake, drinking plenty of fluids, avoiding constipation and using prescription creams. If symptoms persist or the fissure becomes chronic, Botox® injection or surgery may be recommended.
Will I need surgery?
Not necessarily. Most anal fissures heal without surgery. If symptoms persist despite conservative treatment or the fissure becomes chronic, Botox® injection or surgery may be recommended depending on your individual circumstances.
What happens during a Botox® injection?
Botox® is performed as a day-case procedure under a general anaesthetic, so you will be asleep during the treatment. The injection relaxes the anal sphincter, improving blood flow and allowing the fissure to heal over the following weeks.
What should I eat if I have an anal fissure?
A high-fibre diet, plenty of fluids and avoiding constipation can help promote healing. Fruit, vegetables, wholegrains and adequate hydration are all important, and laxatives may sometimes be recommended.
Can anal fissures bleed a lot?
Anal fissures usually cause a small amount of bright red bleeding, which is often noticed on the toilet paper or coating the stool. Heavy bleeding is uncommon and should be assessed by a healthcare professional.
Can anal fissures become infected?
Simple anal fissures do not usually become infected. However, if you develop increasing pain, swelling, fever or discharge, you should seek medical advice as these symptoms may indicate another condition.
What does an anal fissure look like?
An anal fissure is a small tear in the lining of the anal canal. Long-standing fissures may also develop a small skin tag at the edge of the anus.
Is an anal fissure the same as piles?
No. Although both conditions can cause pain and bleeding, they are different conditions and require different treatments. An assessment by a colorectal surgeon can usually distinguish between them.
Can an anal fissure come back?
Yes. Even after successful treatment, fissures can recur, particularly if constipation or other underlying causes are not addressed. Maintaining good bowel habits helps reduce the risk of recurrence.
How much does anal fissure surgery cost?
The cost of treatment varies depending on the procedure performed and whether you are using private medical insurance or paying for your treatment yourself. Please contact us for an individual quotation.