Doctors for Fissure in Dehradun

Anal fissures, referred to as small cuts or tears in the skin surrounding the anal area, can induce intense pain and may result in the presence of red blood spots during bowel movements. Although anal fissures can impact individuals across different age groups, they tend to be more prevalent among infants and middle-aged individuals. Fortunately, many instances of anal fissures can be effectively managed at home, without significant implications for one's overall health. In mild cases, employing stool softeners or opting for pain relief medications can provide relief. However, if these measures fail to alleviate the symptoms, surgical intervention may become necessary to treat the condition.

When it comes to addressing anal fissures, there are various treatment approaches to consider depending on the severity of the condition. These approaches can be broadly classified into non-surgical and surgical methods. Here are the treatment options for fissure in more detail;

• 1. Non-surgical Approach: The non-surgical approach is typically the initial course of treatment for anal fissures, especially in cases where the fissures are mild or in the early stages. The primary goal of this approach is to provide relief from symptoms and facilitate natural healing, avoiding the need for invasive procedures.
1. Local Ointments: After a thorough examination, your doctor may prescribe topical medications or jellies as local ointments. These formulations help reduce swelling, alleviate pain, and mitigate inflammation associated with anal fissures.
2. Oral Medicines: To alleviate discomfort, physicians may recommend oral anti-inflammatory drugs in the form of tablets, capsules, or syrups. It is crucial to adhere to the prescribed dosage and timing. Additionally, oral laxatives may be prescribed to soften stools and promote smoother bowel movements.
3. Sitz Bath: Sitz baths are a popular home remedy for pain relief. By filling a small tub, which can be obtained from your local chemist, with warm water and sitting in it, you can immerse the affected area, providing relief. Sitting in this position for 5-10 minutes and repeating the process 2-3 times a day can offer maximum comfort in alleviating pain.
• 2. Surgical Approach: The surgical approach is considered when non-surgical treatments have proven ineffective or when the anal fissure is severe, recurrent, or chronic. The aim of surgical intervention is to address the underlying issues causing the fissure and promote healing.
1. Lateral Internal Sphincterotomy: This surgical procedure involves the surgical cutting of the sphincter muscles in the anal area to release tension and facilitate the healing process of the fissure. There are two methods of performing a sphincterotomy: an open sphincterotomy, where a small incision is made in the skin and left open for healing, and a closed sphincterotomy, where a blade is passed beneath the skin to reach and cut the muscle. This surgical option is highly effective in treating anal fissures.
2. V-Y Advancement Flap: The V-Y advancement flap is a surgical technique used to treat complex or chronic fissures. During this procedure, a flap of tissue is created near the fissure and then advanced to cover the fissure site. By doing so, it promotes healing and reduces the likelihood of recurrence. This approach is particularly effective when the fissure is associated with a tight internal sphincter muscle.
3. Fissurectomy: Fissurectomy involves complete removal of the fissure. This method is employed for chronic or recurrent fissures that haven't responded to non-surgical treatments. By excising the damaged tissue, fissurectomy aims to alleviate pain and encourage the growth of healthy tissue.
4. Laser Fissure Treatment: Laser fissure treatment, also known as laser sphincterotomy, is a minimally invasive procedure performed using specialized laser technology. By making a small incision in the internal sphincter muscle, the laser helps relax the muscle and improves blood flow to the area. This approach offers the benefits of precision and minimal tissue damage, resulting in reduced post-operative pain and faster recovery.

Determining the necessity of surgery for anal fissures involves careful evaluation of various factors. Here are the crucial indicators that suggest when surgical intervention may be required;

• Persistent and Resistant Fissure: In cases where an anal fissure becomes chronic and remains unresponsive to alternative treatments, such as topical ointments, oral medications, and lifestyle adjustments, surgery becomes a viable consideration.
• Intense Symptoms: Surgery may be warranted when the symptoms associated with the anal fissure are severe and significantly impact daily life. These symptoms encompass excruciating pain, frequent bleeding, difficulty in bowel movements, and recurrent infections.
• Recurring Fissures: The recurrence of anal fissures, characterized by repeated episodes, can signify the need for surgery. Such recurrences often indicate an underlying anatomical or functional issue that necessitates surgical correction for effective resolution.
• Ineffectiveness of Non-surgical Treatments: When non-surgical approaches, including medication, lifestyle modifications, and sitz baths, have proven futile in delivering satisfactory outcomes or complete healing, surgery may be deemed a viable alternative.

In order to determine the need for fissure surgery and assess any underlying conditions, your physician may recommend several diagnostic tests tailored to your specific case. Here are the commonly employed diagnostic methods;

• Anoscopy: A slender tube is gently inserted into the anus, allowing the doctor to obtain a clear visual examination of the rectum and anal region. Anoscopy helps in identifying any abnormalities, inflammation, or structural issues contributing to the fissure.
• Colonoscopy: Typically recommended for individuals over the age of 50 or those with an elevated risk of colon cancer, this procedure involves the insertion of a flexible tube into the rectum to visualize the entire colon. It enables a thorough assessment of the colon's health and aids in ruling out any additional complications.
• Flexible Sigmoidoscopy: Primarily performed on patients below 50 years of age without significant colon cancer risk factors, this procedure employs a thin, flexible tube equipped with a video camera. By inserting it into the rectum, the doctor obtains a detailed visual examination of the rectum's inner lining and the lower part of the colon.

Fissure surgery may be recommended by your doctor in cases where other conservative treatment methods have proven ineffective in managing chronic anal fissures or when the symptoms are severe. Here is the detailed overview of each and every step of this operation;

• Prior to the Surgery
1. To determine the necessity of surgery, your doctor will conduct a comprehensive physical examination, including a visual inspection of the anal region. In some instances, additional diagnostic tests such as sigmoidoscopy or colonoscopy may be advised to eliminate any underlying conditions or uncertainties in the diagnosis.
2. Patient Preparation: Fissure operation is commonly performed under local anesthesia, although general anesthesia may be required for complex cases or patients who experience anxiety or have difficulty cooperating. The patient will be positioned in a prone jack-knife posture with the buttocks gently separated.
3. Anoscopy: During the procedure, an anoscope, which is a tubular instrument, will be employed to provide optimal visualization of the rectum and anus.
4. Sigmoidoscopy: For patients under the age of 50 with no significant risk factors for colon cancer or gastrointestinal conditions, a slender and flexible tube equipped with a small video camera at its tip will be inserted into the lower part of the colon to obtain a detailed visual representation.
5. Colonoscopy: If the patient is over 50 years old, or exhibits risk factors or symptoms suggestive of colon cancer or related conditions, a flexible tube will be inserted into the rectum to comprehensively examine the entire colon.
• During the Surgical Procedure
1. The surgical approach for anal fissures may vary depending on the individual's specific condition. Below is a detailed, step-by-step explanation of two commonly employed techniques:
2. Lateral Internal Sphincterotomy: Under the effect of general anesthesia, the skilled surgeon will meticulously perform a lateral internal sphincterotomy, which involves incising the sphincter muscles in the anal region to relieve tension and facilitate the healing process of the fissure. The duration of the procedure is typically brief, lasting only a few minutes. Following the surgery, some patients may experience pain for a few days, and although there is a slight risk of incontinence, this usually improves over time.
3. Anal Advancement Flaps: In this procedure, a section of healthy skin is carefully obtained and skillfully sutured in place to replace the damaged area of the fissure. Anal advancement flaps are generally recommended when there is a higher likelihood of incontinence. However, this technique is considered to be less effective compared to lateral internal sphincterotomy.
• Post-Surgery Care
1. Anal fissure surgeries are generally performed as outpatient procedures, allowing patients to return home on the same day. It is crucial to allow sufficient rest until the effects of anesthesia have fully subsided. Following the surgical intervention, patients must diligently adhere to the post-operative care instructions provided by the esteemed medical team. These instructions may encompass pain management strategies, wound care protocols, and dietary guidelines. The duration of recovery varies among individuals, yet most individuals can resume their routine activities within a few days.
2. During the healing process, it is normal to experience mild bleeding and anal discharge. However, if severe discomfort, excessive bleeding, or fever occurs, always consult your doctor.

The primary goal of fissure surgery is to facilitate relaxation of the anal sphincter muscles, thereby mitigating pain, reducing spasms, and fostering the healing process of the fissure. Here are other common benefits of fissure surgery;

• Swift Recovery: One of the significant advantages of choosing fissure operation is the prompt recovery it provides. Following the procedure, many patients experience notable improvements in their condition within a relatively short period.
• Pain Relief: Fissure surgery often leads to a substantial reduction in pain. Through a sphincterotomy, the surgeon effectively releases tension in the anal sphincter muscles, which are responsible for causing discomfort and spasms. As a result, patients commonly report a significant decrease in pain levels after the surgery, greatly enhancing their overall quality of life.
• Relief in Symptoms: In addition to pain relief, fissure surgery brings relief from various associated symptoms. Anal fissures can cause distressing symptoms such as bleeding, itching, and discomfort during bowel movements. By relaxing the anal sphincter muscles, fissure surgery effectively addresses these symptoms, providing patients with much-needed relief and restoring their overall comfort.
• Promotes Healing: Another notable benefit of fissure operation is its ability to promote the healing process of the fissure itself. By reducing tension in the anal sphincter muscles, the surgical procedure improves blood circulation to the affected area, facilitating the healing process. Enhanced blood flow supports the growth of healthy tissue, leading to the closure of the fissure and restoration of normal anal function.

Fissure surgery, particularly lateral internal sphincterotomy, can have several side effects that patients should be aware of. It's important to note that not everyone will experience these side effects, but having knowledge about them can help individuals make informed decisions and seek appropriate medical care if necessary.

• Infection: Infections can sometimes occur as a complication after fissure surgery. While it's normal to have some discharge and swelling during the recovery period.
• Bleeding: Both immediate and delayed bleeding can happen after fissure operation. Minor bleeding is common and may be noticed when passing stools, with the presence of small clots and bright red blood. Bleeding within the first 24 to 48 hours after the procedure is more likely due to a loss of control over the vascular pedicle. Bleeding occurring after two weeks is often associated with infection or localized trauma.
• Risk of Fistula Development: Although rare, there is a slight risk of developing a fistula following surgery. This can happen when there is persistent drainage and a wound that fails to heal properly.
• Incontinence: Incontinence is a potential complication that can occur after the surgery. The use of local anesthetics can help minimize nerve irritation and post-operative discomfort. Factors such as age and gender may influence the likelihood of experiencing incontinence. Common symptoms include pain, discomfort, a feeling of incomplete bowel movements, and frequent urges to urinate. In cases where excessive intravenous fluids are given, urinary retention may also occur.
• Muscle Tear: Although rare, there is a small possibility of damaging the anal sphincter, surrounding muscles, or nerves during or after surgery. This can be caused by factors such as direct heat, mechanical stress, or subsequent infections. Muscle tear may lead to incontinence.

It typically takes about six weeks for the anus to fully heal, many individuals find that they can resume their regular activities, including work, within one to two weeks after the surgery. After undergoing treatment for an anal fissure, it's important to take certain measures to ensure a smooth recovery. Here are some guidelines to aid in your healing process;

• Take it Easy: Give yourself ample time to rest and avoid engaging in strenuous activities for at least one week after the procedure. Allowing your body to recover without exertion is crucial for optimal healing.
• Soothing Sitz Baths: Taking sitz baths three times a day can provide soothing relief. Additionally, it's recommended to take a sitz bath after every bowel movement during the initial days post-treatment. This simple practice involves sitting in a basin of warm water to cleanse and alleviate discomfort in the anal area.
• Embrace High-Fiber Foods: Incorporate fiber-rich foods into your diet to prevent constipation, which can exacerbate symptoms and hinder the healing process. Fresh fruits, vegetables, whole grains, and legumes are excellent sources of dietary fiber. They promote regular bowel movements and soften the stool, reducing strain on the healing fissure.
• Stay Hydrated: Drink 7-8 glasses of water daily to maintain proper hydration. Ample water intake helps keep the stool soft and easy to pass, alleviating pressure on the healing fissure.
• Medications and Ointments: Follow your doctor's instructions regarding any over-the-counter medications or ointments prescribed for pain relief or to aid in the healing process. These may include stool softeners, pain relievers, or topical creams. Adhering to the prescribed regimen can help alleviate discomfort and promote healing.
• Regular Follow-Ups: Attend your scheduled follow-up appointments with your doctor, typically around three weeks after the treatment. These visits allow your doctor to monitor your progress, address any concerns, and provide further guidance if needed.
• Maintain Good Hygiene: Practicing proper anal hygiene is crucial to prevent infection and promote healing. After each bowel movement, gently cleanse the area with mild, fragrance-free soap and warm water. Pat dry or use a soft towel to avoid irritation.
• Minimize Straining: Avoid straining during bowel movements to prevent unnecessary pressure on the healing fissure. If you experience difficulty passing stool, consult your doctor about the use of stool softeners or gentle laxatives as appropriate.
• Patience is Key: Remember that healing takes time, and everyone's recovery timeline may vary. It's essential to be patient and allow your body the necessary time to heal. Managing stress and anxiety can also contribute to a smoother recovery, so consider incorporating relaxation techniques like deep breathing exercises or meditation into your routine.