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Treatment

Choosing Treatment
For An Anal Fissure

Most fissure treatment will start with soft stool and prescription cream. If a fissure does not heal, Botox can relax the muscle for a time which helps healing. Sphincterotomy is established and effective but has a bowel-control risk. Laser fissure treatment is a newer option with less mature evidence.

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Step 1

Make Bowel Movements Easier

The tear cannot heal well if hard stool or repeated diarrhoea keeps injuring it. Treatment starts with the cause.

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Step 2

Relax The Spasm

Prescription ointment or Botox can reduce muscle spasm and improve blood flow. Botox wears off, and some people need another injection or a different procedure.

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Step 3

Consider a Procedure

Lateral internal sphincterotomy makes a small controlled cut in the tight muscle and has strong healing evidence. It may not suit someone with weak bowel control or an old sphincter injury. A laser fissure procedure may be considered for selected patients after a full discussion of the less certain evidence.

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At Feylix

Any procedure offered at Feylix is planned under local anaesthetic. If general anaesthetic, imaging or hospital care is the safer route, you will be referred rather than treated in the clinic.

Laser Anal Fissure Treatment Compared With Lateral Internal Sphincterotomy

This table refers to a sphincter-preserving laser procedure, such as laser fissurectomy or LaFiP, rather than using a laser to cut the sphincter.

Point

LaFiP

Lateral Anal Sphincterotomy (LAS)

What Happens
Laser energy treats the long-standing fissure and scarred tissue, aiming to encourage fresh healing without dividing the sphincter muscle.
A small part of the tight internal anal sphincter is divided. This reduces spasm and improves blood flow so the fissure can heal.
Bowel-Control Muscles
The sphincter is normally preserved, which may be helpful.
LIS deliberately divides part of the sphincter. It can rarely cause a new problem controlling wind or stool.
Pain and Recovery
Small early studies suggest a short procedure and fairly quick recovery, but results have not been confirmed in large comparative trials.
Pain from the fissure often improves quickly. There is a small surgical wound, and full healing still takes time.
Healing and Recurrence
Healing is not guaranteed. Further treatment, Botox or LIS may be needed if pain or the fissure continues.
LIS has a high and well-established healing rate. Recurrence is generally low, but the effect on the muscle is permanent leading to a risk of faecal incontinence
Strength of Evidence
Laser treatment is newer and the published evidence remains limited.
LIS is the established surgical treatment for a chronic fissure that has not healed with stool-softening care, creams or Botox.

Laser treatment may offer a sphincter-preserving option for selected patients, but its long-term results are less certain. Lateral internal sphincterotomy has stronger evidence for healing, although it carries a risk of faecal incontinence.

Questions People Ask

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Many prescription creams are used for several weeks. Your plan depends on how long the fissure has been present and how severe the pain is.

Botox relaxes the muscle for a time. Temporary leakage is possible but is usually less of a concern than permanently cutting muscle.

It can heal fissures well, but the effect on the sphincter is permanent. Existing weakness, childbirth injury and bowel control must be considered.

It may help refresh chronic scarred tissue and reduce spasm-related disease with limited cutting, but published evidence whilst exciting does not show how recurrence rates.

Yes, especially if constipation, hard stool or diarrhoea returns.

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