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What Is an Anal Fissure?

An anal fissure is a small tear in the lining of the anal canal, the final part of your digestive tract where stool exits the body. It typically develops when the lining is stretched beyond its limit, most commonly from passing large, hard stools or during repeated episodes of diarrhoea.

Despite its size, this tear can cause sharp, intense pain because the area is highly sensitive and controlled by the anal sphincter muscle.

In many cases, the tear exposes underlying tissue, leading to pain during and after bowel movements, often accompanied by fresh red bleeding on toilet paper or in the bowl. The sphincter muscle may tighten in response, reducing blood flow and slowing the healing process, often increasing discomfort.

Causes of Anal Fissures

Understanding what triggers a fissure and what prevents it from healing is key to managing anal fissures effectively in Singapore.

Constipation, Hard Stools and Straining

Passing large or hard stools is the most common cause. Straining increases pressure in the anal canal, making the delicate lining more likely to tear.

Diarrhoea and Repeated Irritation

Frequent loose stools can also irritate and inflame the anal lining, leading to small tears that worsen over time.

Lifestyle and Bowel Habits that Increase Risk

Low fibre intake, dehydration, irregular bowel habits, and delaying the urge to pass stool can all increase strain on the anal canal.

Less Common Medical Causes

Conditions such as inflammatory bowel disease (IBD), infections, or reduced blood flow to the anal area may contribute to fissures that are harder to heal.

Symptoms of Anal Fissure in Singapore

Besides bleeding, the symptoms of anal fissure are often recognisable and can have a noticeable impact on your daily comfort and routine.

You may notice:

Sharp pain during bowel movements, sometimes lasting minutes to hours after
Bright red blood on toilet paper or stool
A burning or tearing sensation in the anal area
A growing fear of passing stool due to pain, which can worsen constipation

These symptoms can create a cycle where pain leads to avoidance, which leads to harder stools and further tearing.

Acute vs Chronic Anal Fissure

Not all fissures behave the same. Some heal quickly, while others persist and become more complex.

An acute anal fissure typically heals within a few weeks with simple care. However, chronic anal fissures refer to those that last longer than six to eight weeks or keep coming back.

Chronic fissures may develop:

A skin tag (sentinel pile) at the edge
Thickened edges around the tear
Ongoing muscle spasm, which reduces blood flow and delays healing

What Causes Anal Fissures to Become Chronic

For those needing treatment for chronic anal fissures in Singapore, several factors may be involved:

Persistent tightening (spasm) of the anal sphincter muscle
A cycle of constipation and re-injury
Delayed or incomplete treatment in the early stages

Read on to learn more about the differences between acute and chronic anal fissures.

In Singapore, chronic anal fissures are treated with medication and this has an 80% to 90% chance of successful treatment. The aim of medical treatment is to heal the anal tissues and break the pain cycle. Pain is treated with painkillers, anal spasms are treated with Rectogesic ointment, and constipation is managed with laxatives. The tear will usually heal with such treatments. Failure to recover despite medical treatment is an indication for anal fissure surgery (10% to 20%). Chronic anal fissure treatment primarily focuses on alleviating pain and facilitating healing, often involving a combination of medication, lifestyle adjustments, and sometimes surgical options.

How Anal Fissures Are Diagnosed in Singapore

Diagnosing an anal fissure is usually straightforward and focused on identifying the cause of your symptoms accurately.

Medical history and symptoms: Your colorectal specialist will ask about pain during bowel movements, bleeding, bowel habits, and how long your symptoms have been present.
Gentle physical examination: A careful visual inspection of the anal area is often enough to confirm the presence of a fissure. This is done gently to minimise discomfort.
Distinguishing from other conditions: It’s important to rule out other causes of rectal bleeding, such as haemorrhoids, infections, or less common colorectal conditions.
Further evaluation if needed: If symptoms are unclear, persistent, or atypical, additional tests may be recommended to ensure an accurate diagnosis and appropriate treatment plan.

Anal Fissure Treatment Options in Singapore

Treatment for anal fissures in Singapore follows a step-by-step approach, starting with simple measures and progressing if needed.

Conservative and Home-Based Treatment

Early treatment often focuses on relieving strain and promoting natural healing:

Increasing dietary fibre (fruits, vegetables, whole grains)
Drinking enough water to soften stools
Taking warm sitz baths to relax the anal muscles and improve blood flow

These steps can significantly reduce pain and support healing, especially in acute cases.

Medications for Acute and Chronic Anal Fissures in Singapore

For more persistent symptoms of acute and chronic anal fissures, treatment in Singapore may include:

Topical creams or ointments to reduce pain and improve blood flow
Stool softeners to prevent further tearing
Muscle relaxants to reduce sphincter spasm and aid healing

These treatments target both the symptoms and the underlying causes of delayed healing.

Injection-Based Treatments for Chronic Anal Fissures

In cases that do not respond to medication, botulinum toxin injections may be considered.

These injections temporarily relax the anal sphincter muscle, reducing spasm and allowing the fissure to heal. This option is often used before considering surgery.

Learn more about non-surgical anal fissure treatment.

When Is Anal Fissure Surgery Necessary in Singapore

Surgery for anal fissures may be recommended in Singapore when:

Symptoms persist despite medication
Fissures keep recurring
Pain and bleeding significantly affect the quality of life

Surgery is typically considered for chronic anal fissures that have not responded to other treatments.

Anal Fissure Surgery Options and Recovery

The most common procedure is lateral internal sphincterotomy, where the surgeon releases a small part of the sphincter muscle to ease tension and allow the fissure to heal properly.

What to expect:

Done as a day surgery, so you can usually go home the same day
A reliable option for chronic fissures that haven’t responded to other treatments
Many people notice relief within a few weeks
The procedure is carefully performed to maintain bowel control (continence)

Learn more about surgical anal fissure treatment.

Anal Fissure Surgery Cost in Singapore

The cost of anal fissure surgery in Singapore can vary depending on several factors, but in general, you can expect a range of SGD 2,000 to SGD 8,000.

Costs depend on:

Public vs private setting: Subsidised rates in public hospitals are typically lower, while private care offers shorter waiting times and more personalised services.
Complexity of the condition: Chronic or recurrent fissures may require more involved treatment.
Surgeon’s expertise and facility fees: Professional fees, operating theatre charges, and anaesthesia all contribute to the total cost.
Insurance coverage and claims: MediSave, MediShield Life, or private insurance may offset part of the cost.

A personalised consultation is necessary to provide an accurate estimate based on your condition, treatment approach, and coverage eligibility.

Preventing Anal Fissures and Recurrence

Preventing recurrence is just as important as treating the fissure itself. Small daily habits can make a significant difference in long-term comfort and bowel health.

You can reduce your risk of anal fissures by:

Maintaining a high-fibre diet
Staying well hydrated
Avoiding straining during bowel movements
Going to the toilet when you feel the urge
Practising good anal hygiene without over-irritation

When to See a Colorectal Surgeon for Anal Fissures in Singapore

Early assessment helps prevent your condition from becoming chronic and allows you to explore appropriate treatment options tailored to your needs.

You should seek medical advice if you experience:

Persistent or severe pain during bowel movements
Recurrent anal fissure bleeding
Symptoms lasting more than a few weeks
No improvement with home treatment

How We Can Help With Hemorrhoids (Piles Surgery In Singapore)

Dr QM Leong is an experienced colorectal doctor with relevant medical specialities in fields such as colorectal cancer and piles treatment in Singapore, who will accurately diagnose your condition for any signs of hemorrhoids before determining the right treatment for your condition.

We are fully committed to providing a pleasant experience, treatment and patient care, so do not hesitate to call to find out about piles surgery in Singapore or make an appointment with us to understand more about hemorrhoids.

Frequently Asked Questions

What Are The Standard Treatments For Anal Fissures?

Standard treatments in Singapore for anal fissures include topical ointments containing nitroglycerin or calcium channel blockers to relax the anal sphincter. Changing your diet by increasing fibre intake and drinking more water can help soften stools.

Medications like painkillers and stool softeners manage pain and prevent constipation. Sitz baths, warm baths to relax the anal muscles, are also commonly recommended.

How Does Treatment For Chronic Anal Fissures Differ From Acute Fissures?

In Singapore, treatment for chronic anal fissures may involve more intensive measures compared to acute fissures. Other measures can include Botox injections to relax the anal sphincter muscles or surgical procedures like lateral internal sphincterotomy to relieve pressure on the fissure.

Long-term use of medications, both topical and oral, may also be prescribed to control pain and promote healing.

How Do I Prepare For Anal Fissure Surgery?

Preparing for anal fissure surgery typically involves consulting with your surgeon in Singapore to discuss the procedure, its risks, and benefits. A medical evaluation ensures you are in good health for surgery.

You will need to follow pre-operative instructions provided by your healthcare team, which may include fasting before anal fissure surgery and discontinuing certain medications as advised.

Does The Cost Of Anal Fissure Surgery Include Post-Operative Care?

The cost of anal fissure surgery in Singapore may or may not include post-operative care. It’s essential to clarify this with your healthcare provider or surgeon before the procedure to understand what expenses are covered. Understand the colonoscopy cost in Singapore by visiting our comprehensive guide that outlines various price ranges and factors influencing them.

What Should I Consider When Evaluating The Cost Of Anal Fissure Surgery?

When evaluating the cost of anal fissure surgery in Singapore, consider all potential expenses involved. Other expenses include hospital fees covering the surgical facility, anaesthesia, and the surgeon’s professional fees.

Additionally, inquire about the coverage of post-operative care, such as follow-up visits, medications, or management of complications. Check with your insurance provider to know what portion of the procedure may be covered under your policy.

What Should I Do If My Anal Fissure Starts Bleeding?

If your anal fissure starts bleeding, take immediate steps to manage it. Gently apply pressure with clean gauze to the area to stop the bleeding. Avoid straining during bowel movements and take steps to prevent constipation.

If bleeding persists or if you experience excessive bleeding, seek medical advice promptly from your healthcare provider in Singapore.

What Are The Risks Associated With Bleeding Anal Fissures?

Bleeding anal fissures can pose several risks, including anaemia due to chronic blood loss. There is also a risk of infection, especially if the area becomes irritated or contaminated.

Persistent bleeding may indicate that the fissure is not healing properly, potentially leading to chronic issues or complications. Monitoring anal fissure bleeding closely and consulting a healthcare professional in Singapore for appropriate evaluation and management is essential.

About Dr QM Leong

Colorectal & Hernia Surgeon in Singapore

Dr Leong is a general and colorectal surgeon in Singapore who graduated from the University of London in 2000. He obtained his membership to the Royal College of Surgeons of Edinburgh in 2003 and started working in Tan Tock Seng Hospital in 2003. He started his Advanced Specialist Training in 2005 and passed his fellowship exams in 2008. Dr Leong was awarded the prestigious MOH HMDP scholarship to train under Prof Kim Seon Hahn in Korea University for Laparoscopic and Robotic colorectal surgery in 2010.

Dr Leong is amongst a handful of hernia and colorectal surgeons in Singapore who practice Single Incision Laparoscopic surgery. This is a technical and complex procedure that is minimally invasive, speeds up recovery, and confers excellent cosmetic results. Dr Leong also routinely trains basic and advanced specialist trainees in laparoscopic surgery, and regularly proctors consultant surgeons in complex colorectal cases.

Beyond laparoscopic surgery, Dr Leong also performs a repertoire of minimally invasive General Surgery procedures. He is also an experienced endoscopist with more than 10000 procedures, performing diagnostic and therapeutic scopes for elective and emergency surgical conditions. He performs direct access colonoscopies and oesophago-gastro-duodenoscopy for patients and will strive to perform the procedures on the same day if possible for patients’ convenience.

About Dr QM Leong

Colorectal & Hernia Surgeon in Singapore

Insurance

Our surgery is on the panel of most of the major insurance companies and if you are covered by corporate insurance, you may be entitled to a cashless visit to our clinic.