Anal Fissure Surgery in Lebanon Diagnosis & Treatment for Acute and Chronic Anal Fissures

An anal fissure is a tear in the delicate tissue lining the anal canal.

Fissures commonly develop after trauma to the anal canal, particularly from passing hard or large stools. Persistent muscle spasm can reduce blood flow to the affected area and interfere with healing, contributing to the development of a chronic fissure.

Anal fissures may be classified as:

Acute Anal Fissure

A recently developed fissure that may heal with conservative treatment and improved bowel habits.

Chronic Anal Fissure

A fissure that persists over time or repeatedly returns despite initial treatment. Chronic fissures may require additional medical or surgical management.

Typical anal fissure symptoms may include:

• Sharp pain during bowel movements
• Pain that continues after passing stool
• Bright red bleeding
• Burning or irritation
• Fear or avoidance of bowel movements because of pain
• Visible tear near the anal opening in some cases

Symptoms can resemble those of hemorrhoids or other anorectal conditions. Accurate diagnosis is therefore important before treatment begins.

Anal fissures may develop following trauma or increased pressure within the anal canal.

Common contributing factors include:

• Constipation
• Hard or large stools
• Excessive straining
• Repeated diarrhea
• Increased anal sphincter muscle tension
• Childbirth in some patients

Treating contributing bowel habits is an important part of both healing and reducing recurrence.

Diagnosis usually begins with a discussion of the patient's symptoms and an appropriate clinical examination.

The evaluation aims to determine:

• Whether a fissure is present
• Whether it is acute or chronic
• Its location
• Possible contributing factors
• Whether another anorectal condition may be causing the symptoms

Additional investigations may be recommended when symptoms or examination findings are atypical.

Many acute anal fissures can heal without surgery.

Initial treatment may include:

• Increasing dietary fiber
• Adequate hydration
• Stool-softening measures when appropriate
• Avoiding excessive straining
• Improving bowel habits
• Warm sitz baths
• Medications to reduce pain or sphincter spasm when clinically indicated

The objective is to reduce trauma during bowel movements and allow the fissure to heal.

Surgery is generally not the first treatment for an anal fissure.

Anal fissure surgery may be considered when:

• The fissure becomes chronic
• Symptoms persist despite appropriate conservative treatment
• Pain remains significant
• The fissure repeatedly returns
• Clinical evaluation indicates that surgery is appropriate

Treatment is individualized to balance effective healing with preservation of normal anal function.

Lateral internal sphincterotomy is an established surgical treatment for selected chronic anal fissures.

The procedure involves carefully dividing a controlled portion of the internal anal sphincter muscle. This reduces excessive muscle tension and helps improve blood flow to the fissure, supporting healing.

Patient selection is important. Before recommending the procedure, factors such as symptoms, sphincter function, medical history, previous anorectal procedures, and individual continence risk are considered.

Anal fissures and hemorrhoids can both cause rectal bleeding and discomfort, but they are different conditions.

An anal fissure is a tear in the lining of the anal canal and typically causes sharp pain associated with bowel movements.

Hemorrhoids involve enlarged vascular tissue and may cause bleeding, itching, swelling, or prolapse.

Because symptoms can overlap, examination is important to establish the correct diagnosis.

Learn More about Hemorrhoids →

Maintaining healthy bowel habits can help reduce repeated trauma to the anal canal.

Patients may be advised to:

• Maintain adequate fiber intake
• Drink enough fluids
• Avoid prolonged straining
• Manage constipation early
• Avoid delaying bowel movements
• Follow treatment recommendations after recovery

Long-term management depends on the underlying factors contributing to the fissure.

• American Society of Colon and Rectal Surgeons (ASCRS)
• European Society of Coloproctology (ESCP)
• Evidence-based clinical guidelines for anal fissure management