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Last updated: 18-Oct-2026
Fissure treatment in Ahmedabad by Dr Harsh Shah · Gota OPD, Gota, Ahmedabad · Apollo Hospital, Bhat, Gandhinagar
Most anal fissures heal without an operation. Dr Harsh Shah starts with stool softeners, fibre, warm sitz baths and a diltiazem or GTN ointment for six to eight weeks.
A chronic fissure that does not heal on a full course of medicines is treated with lateral internal sphincterotomy (LIS). It is a short day-care operation that relaxes the tight muscle so the tear can heal.
A fissure that sits off the centre line, or looks unusual, is checked for other causes before any operation is planned.
Two steps. Medicines and stool care for six to eight weeks first. Lateral internal sphincterotomy only for a chronic fissure that has not healed on a proper course.
Dr Harsh Shah has 18 years of experience in gut and anal surgery. He examines the fissure himself, decides whether it is new or long-standing, and does the sphincterotomy himself when it is needed.
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
GI & Proctology Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Google rating 4.89 from 216 reviews at the Gota clinic, and 4.94 from 18 reviews at Apollo, Bhat.
| Your fissure | What Dr Shah advises | How long before review |
|---|---|---|
| New (acute) fissure, in the centre line | Fibre, water, a stool softener and warm sitz baths. A diltiazem or GTN ointment is often added. | Six to eight weeks |
| Long-standing (chronic) fissure, in the centre line | The same stool care plus a diltiazem or GTN ointment, used twice a day, every day. | Six to eight weeks |
| Chronic fissure not healed after a full, correct course | Lateral internal sphincterotomy (LIS), as a day-care operation. | Wound check at about two weeks, healing check at six to eight weeks |
| Fissure off the centre line, more than one fissure, or an unusual look | Tests first, often an examination under anaesthesia with a small tissue sample. | Plan made once the result is back |
| Fissure with low continence reserve (for example after a difficult childbirth) | A longer course of medicines, or a very short, measured sphincterotomy. Referral if a muscle-sparing operation suits you better. | Decided after examination |
Home care for a fissure is explained in our fissure guide. This page covers Dr Shah’s choices at the clinic, the operation, and real recovery.
A fissure is a small tear in the skin lining the anus. It causes sharp, cutting pain during and after a motion, with a streak of bright blood on the stool or paper.
The pain can last an hour after the toilet. Many people then hold the stool back, the next motion is harder, and the skin tears again. Piles more often bleed without much pain, or cause a lump that comes out. Some people have both.
Bleeding from the back passage should always be checked, even when a fissure explains it. In the right patients, such as those over about 45 or with a change in bowel habit, Dr Shah advises a colonoscopy to rule out other causes. Piles have their own page: piles treatment in Ahmedabad.
An acute fissure is a fresh, shallow tear that usually heals with stool care. A chronic fissure has lasted more than six to eight weeks, or keeps coming back, and needs the muscle relaxed.
| Question | Acute fissure | Chronic fissure |
|---|---|---|
| How long | Less than about six weeks | More than six to eight weeks, or comes back again and again |
| How it looks | A clean, shallow cut | A deeper tear with hard, raised edges |
| Tag at the edge | Usually none | Often a sentinel tag outside, and a small lump inside |
| Muscle | May tighten with pain | Stays tight all the time, which keeps the tear short of blood |
| Usual first step | Fibre, water, stool softener, sitz baths | The same, plus a muscle-relaxing ointment |
| If it does not heal | It is treated as chronic | Lateral internal sphincterotomy |
Why does a fissure get stuck? The inner ring of muscle, the internal sphincter, goes into spasm with the pain and squeezes the thin blood supply to the tear. A tear short of blood cannot heal, and the pain keeps the spasm going. Every treatment for a chronic fissure works by relaxing that muscle.
Dr Shah looks for four signs at a gentle examination. Any one of them means the fissure is long-standing and needs more than stool care alone.
The examination is done by looking, with the buttocks gently parted. A painful internal examination is not needed to make the diagnosis.
Ordinary fissures sit in the centre line, at the back or front of the anus. A fissure at the side, or more than one, is checked for another cause before it is treated as a simple fissure.
| Possible cause | Clues | How it is checked |
|---|---|---|
| Crohn’s disease | Several fissures, swollen tags, loose motions, weight loss | Tissue sample, colonoscopy, sometimes an MRI |
| Tuberculosis (TB) | A slow, undermined sore that does not heal; common in India | Tissue sample sent for TB tests |
| Infections, including sexually spread ones | An unusual sore, sometimes with little pain | Blood tests and swabs |
| Other rare causes | A hard, irregular edge, or a sore that will not heal on correct treatment | Examination under anaesthesia and a tissue sample |
This matters because cutting the muscle in these conditions can do harm. A Crohn’s fissure, for example, heals poorly after a sphincterotomy; the Crohn’s itself needs treating. So Dr Shah does not operate on a fissure he has not first confirmed as an ordinary one.
For most fissures, the first plan is soft stools, warm sitz baths and a muscle-relaxing ointment. A full six to eight week course heals many fissures without any operation.
The commonest reason an ointment seems to fail is that it was stopped early. Two weeks of GTN, stopped because of headache, is not a failed course. Stool care stays for life; a healed fissure in someone who stays constipated tends to come back.
LIS is advised for a typical chronic fissure that has not healed after a full, correct course of medicines, or keeps coming back, in a person whose bowel control is safe.
Large reviews of trials show that it heals far more chronic fissures than ointments alone, and fewer come back. It is still an operation on a benign condition, so Dr Shah advises it only after medicines have had a fair chance.
First he asks about any past leakage of gas or stool, childbirths, earlier anal operations and loose motions, and he feels the muscle tone. The answers decide how much muscle can be safely divided, or whether any should be.
The operation takes about fifteen to twenty minutes. A small part of the tight inner muscle is divided at the side of the anus, away from the fissure, so the muscle relaxes and the tear can heal.
In women and anyone with weaker control, the cut is kept even shorter. How much muscle to divide is the key decision, and Dr Shah makes it for each patient.
Many people notice that the old tearing pain is less within a few days. The first few days are sore; pain is controlled with tablets, sitz baths and stool softeners.
| When | What to expect |
|---|---|
| Day of surgery | Home the same evening once you pass urine. Pain tablets on a schedule. Normal food. |
| Days 1 to 3 | Soreness at the small cut, but the deep cutting fissure pain is often less. Sitz baths after each motion. A little blood on the paper is common. |
| Days 4 to 7 | Pain settles further. Most people with desk jobs go back to work within a few days to a week. |
| Week 2 | Wound check at the clinic. Walking, driving and light work are fine. |
| Weeks 3 to 6 | The fissure heals. Gym and heavy lifting are started step by step. |
| Weeks 6 to 8 | Healing check. Dr Shah asks directly about control of gas and stool. |
| Long term | Fibre and water every day, to keep the fissure from coming back. |
Come back at once, or go to the nearest emergency department, with any of these.
LIS is a small operation, but it divides part of a muscle that helps you hold gas and stool. The main risk to understand is a change in that control.
Control of gas and stool. A small number of people notice they control wind less well, or get slight staining of underwear, after the operation. In most it is minor and gets better over weeks to months. Loss of control of solid stool is rare. Studies show the risk is lower when only a short length of muscle is divided, which is how Dr Shah does it.
Who is at higher risk. Women, especially after childbirth, because the front muscle is short and a past tear may have weakened it unnoticed. Also older people, and anyone with an earlier anal operation, a fissure at the front, or frequent loose motions. For them, Dr Shah tailors the plan. He may give medicines longer, divide a very short measured length of muscle, or advise a muscle-sparing treatment elsewhere. He explains which applies to you before you decide.
Other risks: bleeding or a small clot under the skin, infection or a small abscess at the cut, a fissure that does not heal (then checked again for another cause), and a fissure that returns, mostly with constipation. General anaesthesia risks apply. Dr Harsh Shah goes through each of these in person before consent.
Some centres use botulinum toxin injection, fissurectomy or a skin flap. Dr Shah does not provide these. He uses medicines and lateral internal sphincterotomy, and refers when another option suits you better.
| Treatment | What it is | Who it can suit | With Dr Shah? |
|---|---|---|---|
| Stool care and ointment (diltiazem or GTN) | Relaxes the muscle without any cut | Almost everyone, as the first step | Yes |
| Lateral internal sphincterotomy | Divides a short part of the inner muscle | Chronic fissure not healed on medicines, with safe bowel control | Yes |
| Botulinum toxin (Botox) injection | Relaxes the muscle for a few months, then wears off | Some people at higher risk of control problems | No, other centres provide it. Dr Shah does not use it because its effect wears off and the fissure can return. |
| Fissurectomy | Cuts away the scarred edges of the fissure, without dividing the muscle | Some people at higher risk, often with an injection | No, not provided by Dr Shah |
| Anal skin flap (advancement flap) | Moves healthy skin over the fissure | A fissure with a loose, not tight, muscle, or one that keeps returning | No, not provided by Dr Shah |
| Forceful anal stretching | Stretches the muscle by hand | No longer advised by surgeons, because control problems are more common | No |
Medical treatment costs only the consultation and medicines. For sphincterotomy, the estimate depends on the type of anaesthesia, whether it is a day case, and any tests needed first.
A tissue sample, a colonoscopy, an overnight stay and the room type also move the cost. Apollo Hospital, Bhat, works with the major insurers and cashless schemes, and the office handles pre-authorisation. Bring: earlier prescriptions and reports, a list of your medicines, the insurance card and identification. You can also call +91-63555-64601 to ask what to bring.
Many do. Most new fissures heal with soft stools and sitz baths, and many chronic ones heal with a six to eight week course of diltiazem or GTN ointment used correctly.
Six to eight weeks, twice a day, every day. Stopping after a week or two is not a fair trial. Dr Shah reviews the fissure at the end of the course before any operation is discussed.
No. It takes about fifteen to twenty minutes through a small cut at the side of the anus. Most people go home the same day.
A small number of people notice less control of wind or slight staining, mostly for a few weeks to months. Loss of control of solid stool is rare. Dividing only a short length of muscle keeps the risk low, and Dr Shah checks your risk before advising surgery.
Childbirth can weaken the muscle without you knowing. Dr Shah asks about your deliveries and feels the muscle tone. He may give medicines longer, keep the cut very short, or advise a muscle-sparing treatment elsewhere.
A fissure at the side, more than one fissure, or one that will not heal on correct treatment can be caused by Crohn's disease, TB or an infection. A small sample, taken under anaesthesia, finds the cause so the right treatment is given.
It can, mostly when constipation returns. Fibre, water and not straining are a lifelong habit, after medicines and after surgery.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
SF-203, 2nd Floor, Olive Greens, Gota, Ahmedabad.
Consultations, examination of the fissure, the medicine plan and follow-up.
Google: Dr Harsh Shah · 4.89 from 216 reviews
Directions to the Gota clinic · +91-63555-64601
Apollo Hospital, Bhat, Gandhinagar
Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar.
Day-care sphincterotomy and examination under anaesthesia.
Google: Dr Harsh Shah, Apollo Bhat listing · 4.94 from 18 reviews
Directions to Apollo, Bhat · WhatsApp +91-63555-64601
Patients come to Ahmedabad from across Gujarat, including Gandhinagar, Mehsana, Nadiad, Anand, Rajkot and Kutch, and from southern Rajasthan.
Sharp pain and bleeding after every motion, for weeks? Send earlier prescriptions and reports ahead, so the consultation starts with them already read. Heavy bleeding, fever with a painful swelling near the anus, or being unable to pass urine needs the nearest emergency department today. Call +91-63555-64601 · Send the reports ahead on WhatsApp
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