Introduction
Anal fissures and fistulas are uncomfortable and often painful conditions that can severely affect your quality of life. Both conditions are related to the anus and rectum, and while they can often be treated conservatively with medications or lifestyle changes, there are situations where surgery is necessary to provide relief.
In this blog, we’ll explore fissures and fistulas, the difference between them, and when surgery becomes the best option for treatment. If you’re dealing with chronic symptoms or are concerned about your condition, Zymus Hospital offers expert care to help guide you through diagnosis and treatment.
What Are Anal Fissures and Fistulas?
Before delving into when surgery is required, it’s important to understand the difference between anal fissures and fistulas.
Anal Fissures
An anal fissure is a small tear or cut in the skin around the anus, often caused by passing large or hard stools. Symptoms include sharp pain during or after bowel movements, blood in the stool, itching, and discomfort. Fissures are common, and most heal with conservative treatments like high-fiber diets, stool softeners, and sitz baths.
Anal Fistulas
An anal fistula is a small tunnel that forms between the skin and the inside of the anus or rectum. It usually results from an infection in the anal glands, which can cause abscesses. Symptoms include pain, swelling, pus or blood discharge, and itching around the anus. Unlike fissures, fistulas rarely heal on their own and often require surgical intervention.
When Should You Consider Surgery for Anal Fissures?
In many cases, anal fissures heal on their own with proper care and lifestyle changes. However, surgery may be necessary if the fissure becomes chronic or doesn’t heal with conservative treatment.
- Chronic Fissures
A fissure is considered chronic if it lasts longer than 6 to 8 weeks despite conservative treatment. Chronic fissures can cause ongoing pain, discomfort, and difficulty during bowel movements, severely affecting daily life. Surgery may be recommended if other treatments fail to provide relief.
- Recurrent Fissures
Some individuals experience recurrent anal fissures, where the condition heals temporarily but returns after some time. If you suffer from frequent flare-ups, surgery might be the most effective long-term solution to prevent future occurrences.
- Fissures with a Sentinel Pile
A sentinel pile is a skin tag that forms as a result of chronic fissures. If a sentinel pile causes discomfort or blocks the natural healing process, surgery may be required to remove both the pile and the fissure.
- Severe Pain and Discomfort
If you experience severe, constant pain that does not subside with conservative treatments such as ointments, stool softeners, and dietary changes, surgery may be necessary to address the underlying cause of the pain.
When Should You Consider Surgery for Anal Fistulas?
Unlike fissures, anal fistulas do not usually heal on their own and require surgical intervention. Surgery for fistulas is often more complex and depends on the severity and location of the fistula.
- Recurrent or Persistent Fistulas
Fistulas rarely heal without surgery. If you’ve had multiple episodes of abscesses or ongoing drainage from a fistula, surgery is usually the best option to eliminate the infection and prevent further complications.
- Painful Symptoms or Discomfort
If you experience ongoing pain, swelling, or discomfort from the fistula, and conservative treatments such as antibiotics or drainage have not been effective, surgery may be recommended to close the fistula and prevent it from returning.
- Large or Complex Fistulas
In cases where the fistula is large, involves multiple branches, or is located in complex areas (such as close to the anal sphincter muscles), surgery is often the most effective treatment option. Surgery aims to preserve the function of the anal muscles while closing the fistula.
- Fistulas Causing Recurrent Infections
Fistulas often result in recurrent abscesses, leading to repeated infections. If the abscesses continue to recur despite drainage and antibiotics, surgical intervention becomes necessary to prevent further infections and alleviate discomfort.
Types of Surgery for Fissures and Fistulas
Both fissure and fistula surgeries aim to provide long-term relief from symptoms, but the type of surgery will depend on the specific condition and its severity.
Fissure Surgery Options
- Lateral Internal Sphincterotomy
This procedure involves making a small cut in the internal anal sphincter muscle to relieve pressure and promote healing. It’s the most common surgery for chronic anal fissures and has a high success rate. - Fissurectomy
In this procedure, the surgeon removes the tissue surrounding the fissure to allow for proper healing. It’s typically done when other treatments haven’t worked. - Flap Surgery
If a fissure is extensive or has caused tissue damage, a flap surgery may be required, where healthy tissue is used to cover the wound.
Fistula Surgery Options
- Fistulotomy
This is the most common surgery for simple anal fistulas. The surgeon cuts along the length of the fistula to allow it to heal from the inside out. This method is effective for most fistulas. - Seton Placement
For complex or large fistulas, a seton (a piece of surgical thread) is placed inside the fistula to allow drainage and prevent infection while the tissue heals. This may be followed by further procedures to close the fistula. - Flap Surgery
In cases where the fistula passes through or near the anal sphincter, flap surgery may be necessary to repair the tissue and preserve sphincter function. A flap of healthy tissue is used to close the fistula.
What to Expect After Fissure or Fistula Surgery?
The recovery process after surgery can vary depending on the procedure performed and the individual’s health. In general:
- Pain Management: Some pain and discomfort are common after surgery, but your doctor will prescribe pain relief medication to manage this.
- Dietary Changes: You may need to follow a high-fiber diet and stay hydrated to ensure smooth bowel movements and reduce strain during recovery.
- Activity Restrictions: You should avoid heavy lifting, strenuous exercise, or sitting for long periods during the initial recovery phase.
- Follow-Up Appointments: It’s important to attend follow-up appointments to ensure proper healing and address any concerns that may arise.
Why Choose Zymus Hospital for Fissure and Fistula Surgery?
At Zymus Hospital, we specialize in diagnosing and treating a wide range of colorectal conditions, including anal fissures and fistulas. Our experienced surgical team provides personalized care, utilizing the latest techniques to ensure the best outcomes for our patients. We are dedicated to providing you with the relief you need and guiding you through a smooth recovery process.
Book an appointment now at Zymus Hospital to discuss your options for fissure or fistula surgery.
Conclusion
Fissure and fistula surgeries are often necessary when conservative treatments fail to provide relief. If you’re suffering from chronic pain, recurrent infections, or discomfort related to these conditions, surgical intervention can offer long-term relief and improved quality of life. At Zymus Hospital, we provide expert care for both fissures and fistulas, helping you make the best decision for your health.
