Introduction

Anal fissures and fistulas are among the most common yet most under-discussed conditions in India. Patients suffer for months — sometimes years — before seeking help, primarily due to hesitation or lack of clear information about what treatment actually involves.

If you are experiencing severe pain during bowel movements, bleeding, persistent discharge near the anal region, or recurring discomfort that has not responded to home remedies, this guide is written for you.

Fissure and fistula surgery in Ahmedabad has become significantly more accessible and far less intimidating thanks to advanced minimally invasive techniques available at centres like Dr. Gastro’s clinic at Shaleen Multi Speciality Hospital, Sola, Ahmedabad. Understanding your condition, your treatment options, and what to expect before, during, and after surgery is the first step toward lasting relief.

This complete patient guide covers everything you need to know.

What Is an Anal Fissure?

An anal fissure is a small tear or cut in the thin, moist tissue (mucosa) that lines the anus. This tear typically occurs during the passage of hard or large stools and causes intense, sharp pain — often described by patients as “passing glass” — during and after bowel movements.

Fissures are extremely common. They affect people of all ages, though they are especially frequent in young adults and infants.

Types of Anal Fissures

Acute Fissure: A recent tear that has existed for less than 6 weeks. Acute fissures often heal on their own with dietary changes and topical treatments. They are caused primarily by constipation, hard stools, or strain during bowel movements.

Chronic Fissure: A fissure that persists beyond 6 weeks and shows no signs of healing. Chronic fissures develop a cycle of tearing, spasm, and reduced blood flow that prevents natural healing. They typically require medical or surgical intervention.

Common Symptoms of Anal Fissure

• Severe, sharp pain during and after bowel movements — often lasting 30 minutes to several hours
• Burning sensation that persists after defecation
• Bright red blood on toilet paper or in the toilet bowl — distinct from darker bleeding which may indicate other conditions
• Itching and irritation around the anal region
• A visible crack or tear in the skin around the anus
• A small skin tag (sentinel pile) near the tear in chronic cases

What Is an Anal Fistula?

An anal fistula is an abnormal tunnel or tract that forms between the inside of the anus (or rectum) and the skin on the outside, near the anal area. This tunnel develops most commonly after an anal abscess — a pocket of infection near the anus — has either burst on its own or been surgically drained.

Unlike a fissure, a fistula does not heal on its own. Surgical treatment is always required for a fistula.

Types of Anal Fistulas

• Intersphincteric fistula: Passes between the internal and external sphincter muscles. The most common type.
• Transsphincteric fistula: Passes through both sphincter muscles. Requires careful surgical planning.
• Suprasphincteric fistula: Loops above the sphincter complex. Less common, more complex to treat.
• Extrasphincteric fistula: Passes entirely outside the sphincter. Rare and most complex to manage.
• Horseshoe fistula: Extends around both sides of the anus with external openings on both sides. Requires staged surgery.

Common Symptoms of Anal Fistula

• Persistent, foul-smelling discharge from an opening near the anus, often staining undergarments
• Throbbing, persistent pain that worsens when sitting, moving, or during bowel movements
• Swelling and redness around the anal region
• Fever and chills if there is an associated abscess
• Skin irritation around the external opening
• Bleeding during bowel movements in some cases

Key Difference: Fissure vs Fistula

Feature	Anal Fissure	Anal Fistula
What it is	A tear in the anal lining	An abnormal tunnel/tract
Primary symptom	Severe pain during bowel movements	Discharge and persistent pain
Bleeding	Common (bright red)	Possible but secondary
Cause	Hard stools, straining, constipation	Usually follows anal abscess
Self-healing	Possible (acute)	Never — always needs surgery
Surgical need	Only if chronic or recurring	Always required

Causes and Risk Factors

Causes of Anal Fissure

• Passing hard, large, or dry stools
• Chronic constipation or chronic diarrhoea
• Straining during bowel movements
• Childbirth (vaginal delivery)
• Inflammatory bowel disease (Crohn’s disease)
• Anal intercourse

Causes of Anal Fistula

• Perianal abscess (most common cause — up to 50% of abscesses lead to fistula)
• Blocked anal glands
• Crohn’s disease or inflammatory bowel disease
• Tuberculosis (TB) — a significant cause in India
• Sexually transmitted infections (syphilis, chlamydia)
• Previous surgery near the anal region
• Radiation therapy to the pelvic area

Risk Factors for Both

• Low-fibre diet
• Inadequate water intake
• Sedentary lifestyle
• Obesity
• History of anorectal conditions

Diagnosis: What to Expect at Dr. Gastro’s Clinic

At Dr. Gastro’s clinic at Shaleen Multi Speciality Hospital in Ahmedabad, the diagnostic process is thorough yet patient-friendly. Dr. Hamik Chandra Patel conducts a detailed evaluation to confirm the diagnosis and determine the appropriate treatment plan.

Diagnostic Steps

1. Medical History Review Detailed discussion of your symptoms — duration, severity, pattern of pain, bleeding, and discharge — along with your dietary habits, bowel movement frequency, and past medical or surgical history.
2. Physical Examination A gentle visual inspection of the perianal area. In most cases, a fissure or fistula can be identified on visual examination. The external opening of a fistula is typically visible as a small opening near the anus.
3. Digital Rectal Examination (DRE) Used cautiously in fissure cases due to pain. Helps assess sphincter tone and identify internal abnormalities.
4. Proctoscopy / Sigmoidoscopy A small, lighted instrument is used to examine the inside of the rectum and lower colon. Helps identify the internal opening of a fistula and rule out associated conditions.
5. Imaging — MRI Fistulogram For complex or high fistulas, an MRI fistulogram is the gold standard. It maps the exact path of the fistula tract, its relationship to the sphincter muscles, and any secondary extensions — critical information for planning surgery safely.
6. Additional Tests (if needed)

• Ultrasound for abscess detection
• Blood tests for infection or inflammatory markers
• Anorectal manometry to measure sphincter pressure

Treatment Options: From Conservative to Surgical

For Anal Fissure

Conservative Treatment (First-Line for Acute Fissures):

• High-fibre diet — fruits, vegetables, whole grains to soften stools
• Adequate hydration — 8–10 glasses of water per day
• Sitz baths — warm water soaks (without soap) for 10–15 minutes after bowel movements to relax the sphincter
• Topical anaesthetic creams — for pain relief during bowel movements
• Stool softeners — to ease passage until the fissure heals
• Topical nitrates or calcium channel blockers — relax the internal sphincter to improve blood flow and promote healing

When Is Surgery Required for Fissure?

Surgery is recommended when:

• The fissure is chronic (not healed after 6–8 weeks of medical treatment)
• There is recurrent history of fissures
• An anal sphincter spasm is present that prevents healing
• Conservative treatment has failed to provide relief

Surgical Treatment — Lateral Internal Sphincterotomy (LIS): This is the most commonly performed and most effective procedure for chronic anal fissure at Dr. Gastro’s clinic in Ahmedabad.

The procedure involves making a small, controlled cut in the internal anal sphincter muscle to:

• Relieve the chronic muscle spasm
• Restore blood flow to the fissure site
• Allow natural healing to occur

LIS is typically performed as a day-surgery procedure under short general or local anaesthesia. Most patients return home the same day and experience significant pain relief within days.

For Anal Fistula

Important: There is no effective medical treatment for anal fistula. All fistulas require surgical intervention. The goal of surgery is to remove or close the fistula tract while protecting the sphincter muscles and preventing incontinence.

1. Fistulotomy (Laying Open) The most common procedure for simple, low fistulas. The surgeon opens the entire fistula tract, converting it into a groove that heals from the inside out. Highly effective for superficial fistulas with minimal sphincter involvement.
2. Seton Placement A thin surgical thread (seton) is passed through the fistula tract and tied loosely or tightly:

• Loose seton — keeps the tract open to drain, used as a staged approach
• Cutting seton — gradually cuts through the sphincter over weeks, reducing incontinence risk compared to immediate fistulotomy for high fistulas

3. Advancement Flap Procedure A flap of rectal tissue is created and advanced to cover the internal opening of the fistula. Preferred when there is significant sphincter involvement, as it avoids cutting the muscle directly.
4. VAAFT — Video-Assisted Anal Fistula Treatment A minimally invasive technique using a small video scope (fistuloscope) inserted into the fistula tract to:

• Identify all internal openings and secondary tracts
• Destroy the fistula tract from inside using an electrode
• Close the internal opening using a stapler or suture

VAAFT is particularly effective for complex fistulas and offers significant advantages: no cutting of sphincter muscles, minimal risk of incontinence, shorter recovery, and can be performed as day surgery.

5. Laser Fistula Treatment A laser fibre is inserted through the fistula tract to destroy and seal it from within. Minimally invasive, with rapid recovery and low recurrence risk for appropriate cases.
6. Fibrin Glue Injection A biological adhesive is injected to seal the fistula tract. Less invasive but has lower long-term success rates compared to surgical options. Suitable for select cases.

What to Expect: Before, During, and After Surgery

Before Surgery

• Pre-operative blood tests and ECG (if required)
• Bowel preparation — your surgeon will advise dietary restrictions and cleansing
• Stop blood-thinning medications as advised
• Arrange for someone to accompany you on the day of surgery and to assist at home for the first 24–48 hours

During Surgery

• Most fissure and fistula surgeries at Dr. Gastro’s clinic are performed under short general or spinal anaesthesia
• Operating time: 30–60 minutes for most procedures
• Day surgery for most cases — you return home the same day

After Surgery — Recovery and Care

• Pain management: Mild to moderate discomfort for a few days — controlled with prescribed medication
• Sitz baths: Warm water soaks 2–3 times daily and after each bowel movement — accelerates healing and reduces discomfort
• Diet: High-fibre foods and plenty of fluids to maintain soft stools
• Activity: Light walking encouraged within 24 hours. Avoid heavy lifting and strenuous activity for 2–4 weeks
• Return to work: Most patients return to desk work within 5–7 days. Manual labour may require 2–3 weeks
• Follow-up: Regular appointments at Dr. Gastro’s clinic to monitor healing

Why Choose Dr. Gastro for Fissure and Fistula Surgery in Ahmedabad?

Expert Gastro and Laparoscopic Surgeon: Dr. Hamik Chandra Patel at Dr. Gastro clinic brings specialised expertise in gastrointestinal and anorectal surgery. His experience with both routine and complex fistula cases ensures accurate diagnosis and the most appropriate surgical approach for your specific condition.

Advanced Minimally Invasive Techniques: From the gold-standard Lateral Internal Sphincterotomy for fissures to VAAFT and laser treatment for complex fistulas, Dr. Gastro’s clinic offers the full range of modern surgical options — designed to minimise pain, reduce recovery time, and protect sphincter function.

International Standards at Shaleen Hospital: Shaleen Multi Speciality Hospital, located on Science City Road, Sola, Ahmedabad, operates to international healthcare standards. The facility provides a clean, comfortable, and fully equipped surgical environment for day procedures and inpatient care.

Patient-Centred Approach: Every patient at Dr. Gastro’s clinic receives a thorough evaluation before any surgical recommendation is made. Conservative treatment is always exhausted first for fissures. Surgery is recommended only when genuinely needed and always with a clear explanation of the procedure, risks, and expected outcomes.

Convenient Location in Ahmedabad: Located near Mangaldeep Party Plot Road, Science City Road, Sola — easily accessible from across Ahmedabad including Naranpura, Chandkheda, Bopal, Satellite, and Navrangpura.

Conclusion

Fissure and fistula are painful, life-disrupting conditions — but both are highly treatable with modern surgical techniques. Whether your condition is a chronic fissure that has not healed with conservative treatment or a complex fistula requiring advanced surgical planning, early consultation is always the right decision.

Dr. Gastro’s clinic at Shaleen Multi Speciality Hospital, Sola, Ahmedabad, offers specialised expertise in both conditions — combining thorough diagnosis, patient-centred care, and the most advanced minimally invasive surgical options available in Ahmedabad today.

Do not let hesitation delay the relief you deserve.

Book your consultation with Dr. Gastro in Ahmedabad today.

📍 Shaleen Multi Speciality Hospital, Near Mangaldeep Party Plot Road, Science City Road, Sola, Ahmedabad – 380060 📞 9512039041 / 8238092233 📧 drhamikchandra@gmail.com

Book an Appointment →