Anal Piles Fissure: Diagnosis and Treatment

Before we dig deeper towards understanding Diagnosis and Treatment of Anal Piles Fissure, let us first understand what an Anal Piles Fissure is. An anal piles fissure is a minor tear or cut in the thin, moist tissue (mucosa) that surrounds the anus’ lining or in the lining of the anal opening. Such a fissure can become a cause of great discomfort as it leads to persistent itching, pain, and bleeding during bowel movements. An anal piles fissure may occur when you are constipated and put excessive stress when passing hard stools. Usually, it does not take more than a few weeks for these fissures to heal. If, however, the recovery duration has crossed the threshold of 2 months, the patient is recommended to visit the doctor or an anorectal surgeon immediately. At this stage, the doctor may prescribe a Piles Fissure Surgery or other medical treatments. Non-invasive techniques and lifestyle modifications can provide temporary relief and help you find a way to live with Piles Fissure while reducing the discomfort but a Piles Fissure Surgery can get rid of the root cause forever.

As with any medical condition of the human body, so is with anal piles fissures. Firstly, the condition is diagnosed, then treated with conservative medication, then with aggressive medication and finally, if nothing seems to provide the expected result, the option of a Piles Fissure Surgery is considered. And therefore we will take the same course throughout this article.


The first step towards diagnosing any medical condition is acquiring knowledge about the subject’s existing medical conditions. Then, a physical examination is performed which includes an inspection of the anal region. In most cases, the cut or tear is clearly visible and this examination is all the doctor needs to confirm that you do have an anal piles fissure. 

Depending upon how recent the tear is, the doctor might put it in either of the two categories viz. Acute or Chronic. An acute anal fissure looks more like a fresh tear, a surface cut, quite similar to a paper cut, while a chronic anal fissure, typically, has a deeper tear, and possibly accompanied with internal or external fleshy growths. Additionally, an anal piles fissure is also termed as chronic if it lasts for more than eight weeks unhealed.

For Piles Fissure Treatment, the fissure’s location can offer clues about its cause. A fissure occuring on the side of the anal opening, instead of the back or the front, is more likely to be associated with another disorder, such as Crohn’s disease. If the doctor suspects you having an underlying condition, he or she might further recommend you for one or more of the following

  • Anoscopy. It is a process in which an anoscope, a tubular device, is inserted into the anus to assist the doctor to visibly inspect the rectum and anus.
  • Flexible sigmoidoscopy. In this technique, the doctor will insert a thin, flexible tube with a tiny video feed into the bottom portion of your colon. This test is usually performed if the patient is younger than 50 and does not have any risk of intestinal diseases or colon cancer.
  • Colonoscopy. Here, the doctor inserts a flexible tube into your rectum to inspect the entire colon region. This test may be recommended if you are older than age 50 or have risk factors for colon cancer or other symptoms such as abdominal pain or diarrhoea.


Anal piles fissures often heal within a few weeks if you take measures to keep your stool soft, such as increasing your dietary fiber intake and fluid intake. Additionally, soaking in warm water for 10 to 20 minutes a few times a day, especially after bowel movements, can help relax the sphincter muscle and accelerate the healing process. If , however, the symptoms persist, further piles fissure treatment is most likely needed.

Nonsurgical treatments for Piles Fissure Treatment

Oral and Topical Medications:

There are so many over the counter drugs and medications available for piles fissure treatment.

  • Nitroglycerin applied externally (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is typically considered the treatment of choice for piles fissure treatment when other conservative measures fail. A known side effect, however, is headaches.
  • Topical anaesthetic ointments such as lidocaine hydrochloride (Xylocaine) may prove helpful as far as pain relief is concerned.
  • Injecting Botulinum toxin type A (Botox), to paralyze the anal sphincter muscle and relaxing those spasms.
  • Blood pressure medications can also help relax the anal sphincter. These medications may be taken orally or applied topically and may be used when Nitroglycerin is no longer effective or causes significant side effects for Piles Fissure Treatment.

Lifestyle and home remedies:

Various changes in lifestyle may help relieve the discomfort and promote healing of an anal fissure, and also prevent recurrences:

    • Add fibre to your diet. Eating about 25 to 30 grams of fibre a day can help keep stools soft and improve fissure healing. Fibre-rich foods include whole fruits, vegetables, nuts and whole grains. Fibre supplements can also be used but their consumption should be increased gradually as sudden increase in fibre may result in gas and bloating.
    • Drink adequate fluids. Fluids help prevent constipation.
    • Avoid straining during bowel movements. Straining generates excessive pressure, which can open a healing tear or even cause a new tear to occur.
  • Exercises. Yoga, Pilates and other such controlled-movement exercises are a great way to get regular workouts if you have haemorrhoids because you’ll have more control over your movements and especially where you place pressure. Asanas such as Viparita karani (legs-up-the-wall), sarvangasana (shoulder-stands), and sirsasana (headstand) are some of the yoga postures that can provide relief from hemorrhoid-related irritation while also stimulating your core muscle groups. Additionally, swimming and water aerobics can also alleviate haemorrhoid related flare-ups.


If the patient has a chronic anal fissure and it has proven resistant to other treatments, or if the symptoms are severe, the doctor may recommend piles fissure surgery. Doctors usually perform a procedure called as Lateral Internal Sphincterectomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. For chronic fissures, studies have also found that Piles Fissure Surgery is much more effective than any other form of medical treatment. Surgery, however, comes with the small default risk of causing incontinence.