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A fissure that does not heal should be re-examined to determine if an underlying problem that prevents healing exists. This could be due to scarring or muscle spasm of the internal anal sphincter muscle. Those which continue to cause pain and/or bleeding can be corrected by Kshar Sutra Therapy.
Surgery is done under general anaesthesia and consists of cutting a portion of the anal muscle and leaves the wound to heal by the time. This helps the fissure to heal by preventing spasm, which interferes with healing. At times, cutting this muscle may interferes with the ability to control bowel movements. Some surgeons may also remove the fissure and the underlying scar tissue, but it will result in a very big wound that may take 3-4 weeks to heal.
Patients have to stay in the hospital for a day or two. Complete healing occurs in a few weeks, although pain often disappears after a 5-7days.
Kshar Sutra therapy is done under Local anaesthesia (i.e, only anus will be anaesthetised). It includes putting Kshar Sutra (Medicated Alkaline Thread) at a suitable place in the anus, so as the spasm of anal muscles are released. At times, Kshar Sutra is used to take out the whole Fissure , but not necessary in all patients because the actual cause is spasm of anal muscles.
More than 90% of patients who underwent Kshar Sutra Therapy for this problem have no further trouble from fissures, provided that patient has to maintain a good lifestyle.
Absolutely Not..! Persistent symptoms need careful evaluation, however, since conditions other than fissure can cause similar symptoms.
First is that fissure-in-ano is not life threatening, although they can affect your quality of life. Other diseases, which produce the same symptoms, can be more serious. Therefore, if you have a painful anal lump, rectal bleeding, or other anorectal issues, it is important to call your doctor for a consultation. Secondly, is that you should not suffer silently and unnecessarily with continuous anal pain. If you are consistently changing your whole life activities (not exercising, drastic change in diet, avoiding eating out or going to an event, etc.) due to the pain and suffering of a fissure, and all of the conservative measures are not working, you should come in to discuss the Kshar Sutra Therapy as it is 90% effective. If on the other hand your symptoms resolve and only every now and then do you develop a tolerable recurrence I suggest continuing conservative therapy. The bottom line is that if you do not need Kshar Sutra Therapy , you should not even be in the line for a the therapy but when you do need Kshar Sutra Therapy, you should be at the very front of the line to have it done.
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