Anal Fissure Surgery in Ankara, Turkey

Anal fissure surgery is a surgical method used for the definitive treatment of tears in the anal region that cause severe pain during defecation. It is preferred in chronic cases that do not heal with medications and creams.

The most commonly used method in anal fissure surgery is lateral internal sphincterotomy. This procedure is performed by controlled relaxation of the internal anal sphincter muscle, reducing pressure and enabling healing.

The postoperative recovery process is generally fast. Patients can return to daily activities within a few days; however, attention should be paid to hygiene and dietary habits. Fiber-rich foods and adequate fluid intake support a healthy recovery process.

The success rate after anal fissure surgery is quite high. Pain largely disappears, and the risk of recurrence is low. Rarely, uncontrolled gas or stool leakage may occur, so surgical experience is of great importance.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Anal Fissure Surgery in Ankara, to get information about Anal Fissure Surgery prices, the process, and the hospital where Anal Fissure Surgery is performed.

What Is an Anal Fissure?

An anal fissure is a superficial tear that forms on the inner part of the anal canal. It usually occurs due to hard bowel movements, constipation, or childbirth. This condition presents with pain and bleeding during defecation.

What Are the Symptoms of an Anal Fissure?

Anal fissures are small tears in the skin around the anus and can be quite painful. They usually occur during defecation, and symptoms can be noticed immediately. The most common anal fissure symptoms are:

• Sharp, burning pain during or after defecation
• Itching or discomfort around the anus
• Bright red fresh blood on toilet paper or in the stool
• A prolonged aching sensation after defecation
• A small swelling or skin tag around the anus (in chronic fissure)

If symptoms persist or recur, a proctology specialist should be consulted for treatment before it becomes chronic.

What Is Anal Fissure Surgery?

Anal fissure surgery is an operation focused on solving the underlying physiological problem beneath a chronic wound in the anal region. We can think of this problem as a vicious cycle: the tear causes pain; the pain triggers a severe spasm in the internal anal muscles (almost like a cramp); this spasm compresses blood vessels, preventing blood supply—meaning nourishment—to the wound. A wound that cannot be nourished simply cannot heal. The surgery aims to eliminate the muscle spasm, the most critical link in this cycle.

To achieve this goal, modern surgery offers several main methods. Since each patient’s condition is different, the most appropriate technique is decided after examination and evaluation. The basic surgical approaches used are:

• Lateral Internal Sphincterotomy (LIS)
• Fissurectomy and Anocutaneous Flap Surgery
• Botulinum Toxin (Botox) Injection

Lateral Internal Sphincterotomy (LIS) is considered the “gold standard” and is the most common and most effective method in anal fissure surgery. In this procedure, a small portion of the internal anal sphincter muscle responsible for the spasm is cut in a controlled manner from the side where the wound is not present. This small incision provides permanent relaxation of the muscle, reduces pressure in the region, and allows blood flow to return to normal. Once blood supply improves, the wound heals rapidly.

Fissurectomy and Flap Surgery is a “sphincter-sparing” approach in which cutting the muscle is avoided. It is especially ideal for patients who have weak gas-stool control mechanisms or are at risk in this regard. The procedure has two stages: First, with fissurectomy, the chronic, hardened wound tissue that has lost its ability to heal is completely removed. Then, to close the resulting defect, a piece of healthy, well-vascularized skin (a flap) from the adjacent area is advanced and sutured into place. This is like repairing a worn fabric with a sturdy patch.

Botulinum Toxin (Botox) Injection is a less invasive alternative to surgery. In this method, botox is injected directly into the internal anal muscle that is in spasm. Botox temporarily stops the release of the substance that delivers the contraction signal from nerve endings. Thus, the muscle relaxes for about three months. This period usually provides a sufficient window for the fissure to heal. Since its effect is not permanent, it is a valuable option especially for patients who do not want to accept surgical risks or who are not suitable candidates for surgery.

In Which Situations Is Anal Fissure Surgery Performed?

Anal fissure surgery is not a treatment recommended immediately for every patient. Surgery is generally the final and most effective step, used after simpler and more conservative methods have been tried. The situations serious and persistent enough to lead to a surgery decision are those that significantly reduce the patient’s quality of life.

First, there are initial-step methods referred to as “medical treatment.” For a patient to be a candidate for surgery, they generally need to have failed to respond to these treatments for an adequate period (6–8 weeks). These first-step treatments are:

• A fiber-rich nutrition program
• Daily adequate fluid intake (at least 2 liters)
• Warm sitz baths
• Special topical creams with a local muscle-relaxing effect

If healing is still not achieved despite these basic measures, surgery comes into consideration. The main situations that create the need for surgery are as follows:

• The presence of a chronic, treatment-resistant fissure
• Frequent recurrence even if it heals with medical treatment
• Unbearably severe pain that paralyzes the patient’s life
• The development of additional problems such as an abscess or fistula on the basis of the fissure

In summary, the decision for surgery arises out of necessity. If the fissure has become a constant source of pain and anxiety that negatively affects the patient’s daily life, social activities, and psychology, providing a permanent solution through surgical intervention will be the most appropriate approach.

What Are the Risks of Anal Fissure Surgery?

As with any surgical intervention, anal fissure surgery also has potential risks and undesirable effects. These risks vary depending on the type of technique used, the patient’s general health status, and the surgeon’s experience. Being informed transparently about these possibilities before surgery is every patient’s most natural right.

The most frequently asked-about and emphasized risk concerns the effects on gas and stool control. In particular, the LIS operation, which involves cutting the muscle, inherently reduces the resting tightness of the anus to some extent. While this does not lead to a noticeable problem in the vast majority of patients, it may cause some temporary or permanent changes in a small number. Knowing the possible risks of surgery is important for setting the right expectations. The most common potential risks are:

• Gas leakage
• Mild staining or soiling in underwear
• Rarely, difficulty holding liquid stool
• Bleeding at the surgical site
• Infection or abscess formation
• Temporary difficulty urinating
• Failure of the fissure to heal or recurrence

Weakening of gas and stool control (incontinence) is the most important risk of the LIS procedure. Modern surgical techniques—such as “tailored” approaches that cut the muscle only as much as the fissure length rather than excessively—have significantly reduced this risk. Control problems after surgery are usually mild and most often improve within the first few months. The risk of severe, permanent incontinence that affects quality of life is extremely low. In at-risk individuals—such as women who have had multiple vaginal deliveries, those who have previously undergone anorectal surgery, or older patients—alternatives such as flap procedures that do not involve cutting the muscle are considered first. In this way, the safest and most effective method is selected for each patient, and risks are minimized.

How Is Anal Fissure Surgery Performed?

Anal fissure surgery is generally a day procedure that does not require hospitalization. The operation, performed under anesthesia (regional or general), is completed in a short time—about 15 to 30 minutes—depending on the chosen technique.

How Is Lateral Internal Sphincterotomy (LIS) Performed?

In this technique, the aim is to relax the spastic internal anal muscle in a controlled manner. It can be applied with two different approaches. In the “open technique,” the surgeon makes a small incision on the side of the anus and cuts part of the muscle under direct vision. In the “closed technique,” the muscle is cut through a small puncture, guided by the surgeon’s tactile sensitivity. The closed technique may result in less postoperative pain and leave less scarring. Today, the most important point is adopting a “patient-specific” approach that cuts the muscle only as much as necessary rather than along its entire length. This preserves the effectiveness of the procedure while minimizing the risk of side effects. The basic steps of LIS are simple.

• Providing appropriate anesthesia
• Making a small incision or puncture on the side of the anus
• Identifying the internal anal sphincter (IAS) responsible for the spasm
• Cutting the lower part of the muscle in a controlled manner
• Facilitating blood flow by achieving permanent muscle relaxation

How Are Fissurectomy and Flap Surgery Performed?

This method is preferred when the sphincter needs to be preserved. It is essentially a “clean and repair” operation. First, the chronic, hardened wound tissue is completely removed (fissurectomy). This allows the wound to regain a fresh and healthy base. Then, a piece of healthy skin is prepared from the area immediately adjacent to this cleaned site. This skin piece, together with its blood supply, is rotated or advanced—like a door—and positioned over the wound and sutured. In this way, fresh, well-vascularized tissue is transferred to the region. The main principles of this method are:

• Complete removal of non-healing chronic wound tissue
• Creating a healthy wound bed
• Preparing a healthy skin flap from the adjacent area
• Advancing the flap over the wound and suturing it
• Supporting healing by providing fresh blood flow to the area

How Is Botulinum Toxin (Botox) Injection Performed?

This is a non-surgical but surgically effective and quite simple procedure. It can often be performed even in an office setting. Using a very fine needle, a predetermined dose of botox is injected directly into the spastic internal anal muscle. The procedure takes only a few minutes and usually does not cause significant pain.

Postoperative Process After Anal Fissure Surgery

The postoperative period generally begins with great relief for patients. The sharp, tearing pain endured for years is replaced by a milder, more manageable surgical soreness. For successful healing, the patient must carefully follow postoperative care rules.

The First Few Days:

The patient is usually sent home the same day. Pain that begins after the anesthesia wears off is easily controlled with prescribed painkillers. One of the most important issues in this period is the first bowel movement. To prevent it from being traumatic, stool softeners are prescribed. Mild soreness and spotting-type bleeding during the first bowel movement are normal.

The First Week:

During this period, ensuring comfort and hygiene is the priority. Some important steps should be taken to speed up healing. What needs to be done for pain control and wound care includes:

• Using prescribed painkillers regularly
• Taking warm sitz baths at least 3–4 times a day
• Taking a sitz bath especially after every bowel movement
• Cleaning after using the toilet with lukewarm water, not dry paper
• Drying the area gently (by patting or using a hair dryer on a cool setting)
• Using a sanitary pad for discharge or spotting

The Following Weeks (2–6 Weeks):

Patients can usually return to desk jobs and normal daily routines within a week. Sensitivity at the wound site gradually decreases. Full healing and tissue normalization usually take up to six weeks. During this period, there are activity adjustments to be considered:

• Starting light walks early
• Avoiding heavy lifting
• Postponing strenuous sports that require straining
• Avoiding activities that put pressure on the anus, such as cycling

Your surgeon will call you for follow-up visits at certain intervals to monitor the healing process. Attending these visits is important for early detection of any potential problem.

What Should Patients Pay Attention to After Anal Fissure Surgery?

Anal fissure surgery resolves the anatomical part of the problem but does not change the lifestyle habits that caused the fissure in the first place. Therefore, to make the success of the surgery permanent and avoid experiencing this problem again, the patient has some important responsibilities. It is like opening a clean page in life, and that new page needs to be filled with the right habits.

The most critical lifelong focus is bowel habits and diet. The goal is to ensure that stool is always soft, easy to pass, and does not strain the anus. There are basic principles that should be followed to achieve this. The most important dietary recommendations are:

• Lentils
• Chickpeas
• White beans
• Apples
• Pears
• Apricots
• Rolled oats
• Whole wheat bread
• Bulgur
• Broccoli
• Artichoke
• Leeks

In addition to diet, developing proper toilet habits is just as important. These habits protect the anal region from unnecessary strain. For toilet discipline, the following rules should be followed.

• Never postponing the urge to use the toilet
• Not sitting on the toilet for more than 5 minutes
• Not taking distracting items such as a phone or book into the toilet
• Strictly avoiding straining and pushing

Placing a small stool under the feet to facilitate the defecation position

Finally, in any abnormal situation, you should contact your surgeon without delay. There are some warning signs that require seeing a doctor:

• Fever above 38.5°C that does not subside
• Severe pain that does not respond to painkillers
• Persistent bright red or clotted bleeding
• Increasing swelling, redness, and purulent discharge in the anal region
• Inability to urinate for more than 12 hours after surgery

Following these recommendations is the most valuable investment to ensure that the comfort achieved through surgery lasts a lifetime.