Why is anal fissure pain so severe for such a small tear?

The anoderm below the dentate line is somatically innervated and as sensitive as fingertip skin, and it sits on a muscle that goes into spasm when injured. The patient experiences a nerve-rich tear and a sustained muscle cramp simultaneously, which is why a five-millimetre fissure can be more disabling than a much larger wound elsewhere.

How quickly does fissure pain improve after laser treatment?

Most patients notice the character of the pain change within 48 to 72 hours, with the prolonged burning ache after a bowel movement usually the first symptom to resolve because that is the spasm. Complete healing of the fissure takes four to eight weeks.

Can an anal fissure come back after treatment?

Yes, if the underlying cause returns. The procedure resolves the spasm and the wound but does not change diet, hydration or bowel habit. Recurrence is uncommon in patients who maintain soft daily stools and avoid straining, and a written long-term bowel plan forms part of discharge.

Is treatment different for a fissure after childbirth?

Yes. Post-partum fissures are frequently anterior and the sphincter may already have sustained obstetric injury, sometimes occult. Sphincter release in this group is approached cautiously and only after assessing existing function with endoanal ultrasound and manometry. In many post-partum patients the correct treatment is fissure-bed laser therapy with no sphincter release at all.

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Anal fissure · Shaq sharji · شرخ شرجي

Anal fissure treatment in Dubai — break the spasm, let the tear heal.

A fissure is not just a cut. It is a cut held open by a muscle that will not relax and a blood supply that cannot reach it. Laser treatment releases that spasm with millimetre precision and stimulates the tissue to close — without the incontinence risk that follows a conventional open sphincterotomy.

15 minute procedure Controlled, graded release Home the same day Lower incontinence risk

Book a fissure assessment I am in pain — help

The pain–spasm–ischaemia cycle

A tear in the anal lining triggers a reflex spasm of the internal sphincter
That spasm squeezes shut the small blood vessels the tissue needs to heal (ischaemia)
A poorly-supplied wound heals slowly, or not at all, and tears again with the next bowel motion
Laser treatment interrupts the cycle by releasing the spasm — allowing blood flow, and healing, to resume

The full cycle diagram is illustrated in the anatomy section below.

At a glance

First line: 6–8 weeks of medical therapy — genuinely, not as a formality
Procedure: laser sphincterotomy + laser fissure photo-biomodulation
Theatre time: 10–15 minutes
Pain relief: most patients report a marked change within 48–72 hours
Work: 24–48 hours
Best for: chronic fissure that has failed medical treatment

Medically reviewed by Dr Kerim Erdem Ulucay, Specialist General & Laparoscopic Surgeon (DHA-licensed) Last reviewed: 25 August 2026 Next review due: August 2027 Reading time: 8 minutes

Understand it, then decide

The condition and the cure, kept separate

Most fissures never need an operation. Read Component A first — it may save you one.

Component A · The Disease

What an anal fissure is — and why it will not heal

An anal fissure is a longitudinal tear in the anoderm — the specialised, richly innervated skin of the lower anal canal. That innervation is why a tear a few millimetres long can produce pain out of all proportion to its size. Patients routinely describe it as passing broken glass.

Almost every fissure starts with a single hard stool. The interesting question is why the tear does not simply heal the way a cut on your hand would. The answer is a self-sustaining cycle:

Tear → severe pain → reflex spasm of the internal sphincter → raised resting pressure → reduced blood flow to the posterior midline → the tear cannot heal → the next stool tears it again.

The posterior midline — the six o'clock position — is where more than 90% of fissures occur, because it already has the poorest blood supply in the anal canal. When sphincter pressure rises, that is the first territory to become ischaemic. This is the entire rationale of treatment: it is not the tear that needs fixing, it is the pressure.

After around six to eight weeks a fissure is called chronic. The edges become fibrotic and rolled, the fibres of the internal sphincter may be visible at the base, and a sentinel skin tag forms at the outer end with a hypertrophied anal papilla at the inner end. At that point creams alone are unlikely to succeed.

Anal fissure disease overview — anatomy, formation and causes, typing and classification, symptoms and diagnostic methods, and management and treatment options including laser fissurectomy

Anatomy & causes, typing, symptoms, and management options at a glance

Symptoms — the pattern is unmistakable

The classic triad

Sharp, tearing pain during defaecation. Sudden, severe, and instantly recognisable.
A deep burning ache afterwards lasting from thirty minutes to several hours. This is the sphincter in spasm, and it is often worse than the initial pain.
Small amounts of bright-red blood — streaks on the paper or on the surface of the stool, never mixed through it.

Additional features: visible or palpable skin tag; intense fear of opening the bowels, which creates constipation and worsens everything; and — in the UAE's long working day — an inability to sit comfortably through meetings or a commute.

Fissure or piles? A quick differentiation

	Fissure	Piles
Pain	Severe, sharp, defining	Usually none
Bleeding	Streaks, small volume	Can be dripping, larger
Lump	Small fixed tag	Soft, prolapses and reduces
After stool	Burning ache for hours	Settles quickly

Fissures in an unusual position matter. A fissure that is lateral, multiple, painless, or unusually broad and irregular is not a typical fissure. It raises the question of Crohn's disease, tuberculosis, HIV-related disease, syphilis or malignancy, and it needs biopsy and investigation rather than a sphincterotomy.

Acute vs chronic — this determines whether you need a procedure at all

Under 6–8 weeks

Acute fissure

A clean, superficial tear with sharp edges and no secondary features. Around half will heal with conservative treatment alone, and a good proportion of the rest with topical therapy.

Fibre to 25–30 g daily and 2–3 litres of water — non-negotiable in this climate
Osmotic laxative to keep stool soft for the full six weeks, not three days
Warm sitz baths 10–15 minutes twice daily — genuinely relaxes the sphincter
Topical GTN or diltiazem to lower resting pressure chemically
Topical local anaesthetic before defaecation to break the fear cycle

Beyond 6–8 weeks

Chronic fissure

Fibrotic rolled edges, visible internal sphincter fibres at the base, sentinel tag and hypertrophied papilla. Spontaneous healing is now unlikely because the ischaemia is established.

Topical treatment failure rate rises steeply after two months
GTN headaches cause many patients to abandon treatment early
Botulinum toxin gives temporary relief; relapse is common as it wears off
This is the point at which a procedure becomes the reasonable option

Understanding your fissure

Six weeks of conservative treatment, done properly

A high-fibre diet and 2 litres of water a day — softer stool is the single biggest factor
Warm sitz baths 2–3 times daily to relax the sphincter and improve blood flow
A topical relaxant cream (e.g. GTN or diltiazem) applied exactly as prescribed, twice daily
Simple stool softeners so the next bowel motion does not re-tear the fissure

Most "failed" conservative treatment was never done consistently for the full six weeks.

"Is it a fissure or piles?"

Fissure: sharp, tearing pain during and for some time after a bowel motion
Piles: usually painless bleeding, or a lump — pain is less typical unless thrombosed
A visible tear at the back passage on gentle parting points to a fissure
The two can coexist, which is why an examination — not guesswork — confirms it

Treating the wrong condition delays real relief, which is why staging comes first.

Now show me the treatment

Component B · The Laser Treatment

Laser sphincterotomy and fissure healing, step by step

Laser treatment of a chronic fissure addresses both halves of the problem in a single sitting: the pressure that causes the ischaemia, and the wound that will not close.

The release. A fine laser fibre delivers energy to a precisely defined segment of the internal sphincter, producing a controlled, graded relaxation of the hypertonic muscle. The critical difference from a conventional lateral internal sphincterotomy is dose control: a scalpel divides muscle to whatever depth the blade travels, and once divided it cannot be undone. Laser energy is delivered in measured increments, and the surgeon stops at the point where resting pressure has fallen sufficiently.

The healing. Low-level laser energy is then applied to the fissure bed itself — photo-biomodulation. It debrides the fibrotic base, stimulates local microcirculation and promotes fibroblast activity, converting a chronic non-healing wound back into an acute one that the body can actually close.

Where a sentinel tag and hypertrophied papilla are present, both are removed at the same sitting. They are not the cause of the fissure, but they perpetuate irritation and hygiene difficulty, and leaving them behind is a common reason patients feel only partly better.

For patients whose resting pressure is not elevated — a real subgroup, particularly older patients and women after childbirth — sphincter release is deliberately omitted, and treatment focuses on the fissure bed alone. Applying a sphincterotomy to a low-pressure fissure is one of the classic causes of avoidable incontinence.

Laser sphincterotomy for chronic anal fissure showing controlled internal sphincter relaxation

Inside the theatre — the five stages

10–4 minutes
Anaesthesia and pressure assessment

Short general anaesthetic, spinal, or sedation with a perianal block. Resting sphincter tone is assessed under anaesthesia — and where available, anorectal manometry beforehand — to confirm that pressure really is elevated.
24–7 minutes
Examination and confirmation

The fissure is inspected, its position and chronicity documented, and coexisting pathology excluded. An atypical fissure is biopsied rather than treated.
37–11 minutes
Controlled laser sphincter release

Energy is delivered to a defined segment of the internal sphincter in graded increments, with tone reassessed between increments. The endpoint is a measured reduction in resting pressure, not a fixed depth of cut.
411–14 minutes
Fissure bed treatment

The fibrotic base is debrided and low-level laser energy applied to stimulate microcirculation and fibroblast activity. Sentinel tag and hypertrophied papilla are excised where present.
514–15 minutes
Finish

No packing, no sutures in the anal canal, no drain. You are awake within minutes and walking within the hour.

Watch it in motion

Animated illustration — no real patients or staff

Controlled laser sphincterotomy — animated walkthroughGraded energy, sphincter relaxation, natural healing · silent · 12s loop

Benefits over conventional lateral internal sphincterotomy

Graded, reversible dosing

Energy is titrated in increments against measured tone. A scalpel cut is a single irreversible decision made in one second.

Lower incontinence risk

Conventional sphincterotomy carries a recognised risk of minor incontinence to flatus or liquid, quoted across series from a few per cent to over 15%. Controlled laser release substantially reduces that exposure.

Treats the wound as well

Photo-biomodulation of the fissure bed addresses the non-healing wound itself — something a sphincterotomy alone does not do.

Rapid pain relief

Because the spasm is released immediately, most patients notice a marked change in the character of their pain within 48–72 hours.

Day case, minimal downtime

Fifteen minutes in theatre, home the same afternoon, most patients back at a desk within 24–48 hours.

Suits higher-risk patients

Women with previous obstetric injury, older patients and anyone with borderline continence reserve — exactly the group in whom open sphincterotomy is most dangerous.

Pain: an honest comparison

Untreated chronic fissure daily, before treatment

8–9

Laser sphincterotomy first 72 hours after

Open lateral sphincterotomy first 72 hours after

3–4

0–10 visual analogue scale. The striking figure here is the first row: for most fissure patients, post-procedure pain is dramatically lower than the pain they were already living with every day.

Recovery timeline

Day 0Home within hours. Stool softener started immediately — the first bowel movement matters most.

Days 1–3The character of the pain changes: the post-defaecation burning ache typically eases first. Sitz baths twice daily.

Week 1Back at work. Occasional discomfort with hard stool. Fibre and fluid strictly maintained.

Weeks 2–4Fissure epithelialises. Review appointment. Most patients are pain-free with normal bowel movements.

Weeks 6–8Complete healing confirmed. Long-term bowel regimen agreed — this is what prevents a second fissure.

Contact the clinic if: the severe tearing pain returns after initially settling; you develop a fever or increasing swelling; you experience any new difficulty controlling gas or stool; or the fissure has not healed by eight weeks. Each of these has a straightforward answer when raised early.

The procedure, step by step

Controlled laser sphincterotomy, in four steps

The fissure and the underlying internal sphincter spasm are confirmed on examination
A fine fibre delivers a graded, measured dose of energy to a small segment of the internal sphincter
The endpoint is a controlled, partial relaxation — not a full division of the muscle
The fissure itself is left to heal naturally once blood flow is restored

The full illustrated technique diagram is above, in the treatment section.

Patient stories — by consent only

We do not publish stock or invented testimonials on this site
Patients who choose to share their experience — including years of chronic pain before treatment — do so in writing, with explicit consent
Ask us directly and we can put you in touch, where a patient has agreed to be contacted

Ask about patient experiences

Individual results and recovery times vary between patients.

You should not have to dread the bathroom

Fissure pain is among the most disproportionate in medicine — a tear of a few millimetres that dominates your entire day. It is also one of the most reliably treatable things in proctology. Come in and find out which stage you are at.

Book an assessment Describe my symptoms

Every option, not just ours

How laser treatment compares with the alternatives

Conservative treatment comes first for everybody. This is what follows if it fails.

Treatment	Healing	Continence risk	Trade-off
Fibre, fluid & sitz baths	Effective in a large share of acute fissures	None	Always first. Requires six full weeks of discipline, not three days.
Topical GTN / diltiazem	Good in acute, moderate in chronic	None	GTN headaches cause many patients to stop early. Diltiazem is better tolerated.
Botulinum toxin injection	Reliable temporary relief	Low, temporary	Wears off at 3–4 months; relapse is common. Useful as a bridge or a test.
Laser sphincterotomy + fissure laser	High in chronic fissure	Low — graded, controlled release	Treats pressure and wound together. Requires an operating theatre and anaesthesia.
Open lateral internal sphincterotomy	Highest reported healing rate	Recognised risk of minor incontinence	The historical gold standard — and the reason sphincter-sparing alternatives were developed.

Fissure questions

What patients ask before booking

Will an anal fissure heal on its own?

An acute fissure often will, provided the underlying cause is corrected properly — soft stool every day for six full weeks, generous fluid, and warm sitz baths. Once a fissure has been present beyond six to eight weeks and has developed fibrotic edges and a sentinel tag, spontaneous healing becomes unlikely because the local blood supply is now compromised.

Why is my pain so severe for such a small tear?

The anoderm below the dentate line is somatically innervated — as sensitive as the skin on your fingertip — and it sits on a muscle that goes into spasm the moment it is injured. You are feeling a nerve-rich tear plus a sustained muscle cramp at the same time. That is why a 5 mm fissure can be more disabling than a much larger wound elsewhere on the body.

Is laser treatment safer than conventional sphincterotomy?

Regarding continence, yes — the release is graded and titrated against measured muscle tone rather than delivered as a single irreversible cut. Conventional lateral internal sphincterotomy has the highest published healing rate of any fissure treatment, but it carries a recognised risk of minor incontinence to flatus or liquid. The laser approach trades a small amount of that healing certainty for a meaningfully lower risk to your control.

How quickly will the pain improve?

Most patients notice the character of the pain change within 48 to 72 hours — specifically, the prolonged burning ache after a bowel movement is usually the first thing to go, because that is the spasm. Complete healing of the fissure itself takes four to eight weeks, and mild discomfort with a hard stool during that period is normal.

Can a fissure come back after treatment?

Yes, if the cause returns. The procedure resolves the spasm and the wound, but it does not change your diet, your hydration or your bowel habit. Recurrence is uncommon in patients who maintain soft daily stools and rare in those who do not return to straining. A written long-term bowel plan is part of your discharge, not an afterthought.

Do I need to try creams first?

In almost all cases, yes — and properly, for six to eight weeks, not abandoned after ten days. Topical diltiazem or GTN, combined with a genuine bowel regimen, resolves a substantial proportion of fissures without any procedure. If you have already completed an adequate trial and the fissure remains, you have earned the right to discuss a procedure rather than being sent round the same loop again.

I have a fissure after childbirth. Is treatment different?

Yes, and this deserves care. Post-partum fissures are frequently anterior rather than posterior, and the sphincter may already have sustained obstetric injury — sometimes an occult one. Any sphincter release in this group is approached with real caution and only after assessing existing function, ideally with endoanal ultrasound and manometry. In many post-partum patients the correct treatment is fissure-bed laser therapy with no sphincter release at all.

Could my fissure be something more serious?

A typical fissure sits in the posterior midline (or anterior midline in women), is single, and is exquisitely painful. A fissure that is lateral, multiple, painless, broad, irregular or associated with diarrhoea, weight loss or mouth ulcers is atypical and is investigated rather than simply treated — with biopsy where indicated — to exclude Crohn's disease, tuberculosis, sexually transmitted infection and malignancy.