Anal Fissure Surgery in Turkey

Anal fissure surgery in Turkey is a common procedure performed to treat chronic anal tears that do not heal with medication. These fissures often cause severe pain, bleeding, and discomfort during bowel movements. Turkish hospitals provide advanced surgical options, offering high success rates and faster recovery.

Cost of anal fissure surgery in Turkey is considerably lower compared to many Western countries. Treatment packages usually include initial examination, diagnostic tests, surgical intervention, hospital stay, and follow-up care. Affordable prices combined with internationally accredited hospitals make Turkey an attractive destination for patients.

Surgical methods for anal fissure treatment in Turkey often include lateral internal sphincterotomy, which reduces muscle tension and promotes healing. In selected cases, minimally invasive approaches or Botox injections may also be used. Expert colorectal surgeons ensure safe procedures with minimal risk of complications.

Recovery after anal fissure surgery in Turkey is typically quick, with patients resuming daily activities within a few days. Post-operative care involves pain management, dietary adjustments with high-fiber foods, and regular follow-up. Comprehensive medical support ensures effective healing and long-term relief from symptoms.

General Surgery Specialist
Who is Dr. Ahmet Bekin?

Dr. Ahmet Bekin, one of the doctors performing hernia surgeries in Istanbul, is specialized in general surgery. Throughout his medical career, he has gained extensive experience in hernia, reflux, and obesity surgery, as well as advanced laparoscopic and robotic surgical applications. He serves his patients with modern approaches such as minimally invasive surgery, laser surgical treatments, single incision surgery (Single Incision Surgery), endocrine and oncological surgery. He is fluent in Turkish, English, and Arabic.

• 2000 – 2006 Kocaeli University Faculty of Medicine
• 2006 – 2011 Istanbul University Faculty of Medicine (Çapa), Department of General Surgery – Specialization

What Is an Anal Fissure?

An anal fissure is a small tear or cut in the lining of the anal canal, often caused by passing hard or large stools. It leads to sharp pain during and after bowel movements, as well as bleeding and muscle spasms. Anal fissures are typically acute but can become chronic if not treated. Management includes dietary changes, topical medications, and in persistent cases, surgical intervention to relieve sphincter pressure and promote healing.

What Are the Causes of Anal Fissure?

Anal fissures occur when various factors cause tears in the sensitive mucosa of the anal region. Mechanical trauma plays a significant role among these factors. Excessive stretching of the anal canal during the passage of large and hard stools can cause tears in the mucosa. Chronic constipation exacerbates this by increasing the risk of tissue injury due to repeated straining. Conversely, chronic diarrhea can also cause fissures by irritating the anal mucosa.

High resting pressure of the internal anal sphincter (hypertonic sphincter) is another important factor. Increased sphincter tone reduces blood flow to the anal region, making tissue healing more difficult. This creates a vicious cycle where pain increases sphincter spasm and further decreases blood flow. Decreased blood flow makes healing of the anal mucosa more difficult and predisposes to fissure formation. Especially in elderly individuals, decreased local blood flow is a risk factor.

Inflammatory bowel diseases (such as Crohn’s disease and ulcerative colitis) predispose to fissures by causing chronic inflammation in the anal mucosa. In Crohn’s disease, fissures are often located off the midline, which is a distinguishing diagnostic feature. Stretching of the perineal area during childbirth is another common cause in women.

Lack of adequate lubrication during anal intercourse can cause microtrauma and fissures in the anal mucosa. Additionally, sexually transmitted infections (such as herpes, chlamydia, HPV) can weaken the anal mucosa and increase the risk of fissure formation.

Diseases that weaken the immune system (such as HIV, tuberculosis) and situations that increase intra-abdominal pressure, such as chronic cough or sneezing, can also contribute to fissure development. In pediatric patients, constipation and passage of hard stools are the main causes of anal fissures.

How Common Are Anal Fissures?

Anal fissures are an important health issue, though not very common in the general population. The incidence varies according to different populations and study methodologies. In adults, the incidence is estimated to be between 1% and 2%. A study published in the American Journal of Gastroenterology reported this rate as 1.1%. Another study in the journal Diseases of the Colon & Rectum reported a prevalence of 1.2%. Variations in these rates may be due to diagnostic criteria, study design, and participant demographics.

Anal fissures can be seen at any age but most commonly occur in young and middle-aged adults. In children, it is usually related to constipation, while in elderly individuals, it is less common due to age-related changes in bowel habits and anorectal anatomy.

Data regarding gender distribution are mixed. Some studies report a slight male predominance, while others suggest no significant difference between genders. Geographic differences may also affect the prevalence of anal fissures. Higher prevalence rates are reported in regions where low-fiber diets are common.

How Does an Anal Fissure Develop?

An anal fissure usually starts with mechanical trauma in the anal canal, leading to tears in the anoderm. During the passage of large, hard stools, the delicate epithelial tissue of the anal canal is excessively stretched and may tear. Additionally, frequent passage of stools and contact with irritants due to severe diarrhea can also contribute to fissure formation. Fissures most often occur at the posterior midline of the anal canal. This is because blood flow is limited in this region, slowing down the healing process and leading to inadequate nourishment of the tissue.

When the initial tear occurs, a reflex spasm may develop in the internal anal sphincter muscle. This involuntary contraction is seen as the body’s attempt to protect the injured area. However, continuous contraction of the sphincter increases anal pressure, placing more mechanical stress on the fissure area. This initiates a cycle of pain and spasm that hinders healing. Due to continuous spasm, not enough blood can reach the submucosal blood vessels in the fissure area. This condition, called ischemia, causes tissues to receive insufficient oxygen and nutrients, further delaying healing.

Fissures that fail to heal for a long time become chronic. Chronic fissures are deeper than acute ones and often expose fibers of the internal sphincter muscle. Skin tags and hypertrophic anal papillae around the fissure are results of repeated disruption of inflammation and healing processes. Additionally, damage to the anoderm can trigger neurogenic inflammation, which increases the sensation of pain and intensifies spasm through substances released from nerve endings.

What Are the Symptoms of an Anal Fissure?

Anal fissure is a common problem causing intense pain and discomfort around the anus. Symptoms generally manifest as physical and psychological issues that negatively impact the quality of life.

The most common symptom is sharp, severe pain during defecation. This pain occurs as the stool passes over the fissure, irritating sensitive nerve endings in the area. The pain can continue for hours after defecation as a burning and throbbing sensation. This can lead to fear of defecation and an increased risk of constipation.

Irritation as the stool passes over the fissure often causes bright red bleeding. This bleeding can be easily noticed on toilet paper, on the stool’s surface, or in the toilet. Although bleeding is usually mild, it should be carefully evaluated.

In chronic fissures, a small skin tag called a “sentinel pile” may develop around the anus. This structure indicates the fissure has become chronic due to prolonged irritation. Additionally, a visible tear may be present at the fissure site, although this is usually diagnosed through a medical examination.

Persistent itching around the anus may accompany the fissure due to mucus secretion and moisture. Itching can increase discomfort by causing further irritation of the area.

Involuntary contractions of the internal anal sphincter decrease blood flow to the fissure site, making healing more difficult and potentially intensifying the pain.

The expectation of pain during defecation may cause stress and anxiety in patients, leading to changes in bowel habits and worsening of symptoms. It is important to address both physical and psychological effects in treatment.

How Is an Anal Fissure Diagnosed?

Diagnosis of an anal fissure begins with a careful patient history and physical examination. Patients usually present with complaints of severe pain and bright red bleeding during or after defecation. Although these symptoms are typical for anal fissure, a detailed evaluation is needed to rule out other anorectal diseases.

Detailed examination of the anorectal area is essential for diagnosis. In acute fissures, a linear tear located at the posterior midline of the anus may be visible. In chronic fissures, additional findings such as skin tags (sentinel pile) and enlarged anal papillae can be detected. A gentle approach is adopted to ensure patient comfort during examination of the anus. Sphincter tone and pain severity are assessed during rectal examination, but this procedure is performed carefully to avoid increasing pain.

Anoscopy is particularly useful for diagnosing internal fissures. This procedure uses a small instrument to examine the inside of the anus in detail. Anoscopy helps determine the size and location of the fissure and differentiate it from other anorectal diseases.

Anal fissures can be confused with other conditions such as hemorrhoids, abscesses, fistulas, and anorectal tumors. Hemorrhoids are usually characterized by painless bleeding, while abscesses and fistulas involve swelling and purulent discharge. Therefore, a detailed patient history and physical examination are critical for diagnosis.

Imaging or laboratory tests are usually not required in typical cases. However, in atypical or complicated situations, endoanal ultrasonography or magnetic resonance imaging (MRI) may be used. Laboratory tests are performed to rule out inflammatory bowel disease or systemic illnesses, if suspected.

How Is an Anal Fissure Treated?

Treatment of anal fissure depends on the severity, duration, and individual circumstances. Conservative methods are generally preferred initially. Increasing fiber intake in the diet, consuming plenty of fluids, and regular exercise help soften stool and regulate bowel movements. These simple measures reduce pressure in the anal region and support healing of the fissure. Sitz baths relieve anal muscle spasm and improve blood circulation, accelerating the healing process.

Topical treatments include nitroglycerin or calcium channel blockers used to relieve pain and reduce spasm. These medications lower sphincter pressure and speed up healing, though side effects should be managed. Botulinum toxin injections may be used in more resistant cases. This method temporarily relaxes the sphincter muscle, providing effective healing.

Surgical interventions are considered in chronic cases unresponsive to conservative and pharmacological treatments. Lateral internal sphincterotomy (LIS) is the most preferred method due to its high success rate and low risk of complications. Alternatively, procedures such as fissurectomy or anal dilation can be performed. However, the risk of complications should be considered for every surgical method, and the patient should be thoroughly informed.

What Are the Complications of an Anal Fissure?

If an anal fissure is not properly treated in the early period, it can lead to various complications. These complications can negatively affect the patient’s quality of life and cause more advanced and difficult-to-treat conditions.

Acute fissures usually heal within six weeks. However, if appropriate treatment is not applied during this period, the fissure may become chronic. Chronic fissures can affect deeper tissues of the anus, exposing muscle fibers and making healing even more difficult.

Chronic fissures often develop skin folds at their ends, called sentinel tags. These skin tags can be uncomfortable and sometimes confused with other anorectal diseases, complicating the diagnosis and treatment process.

Untreated fissures can lead to persistent spasm of the anal sphincter muscle. This spasm reduces blood flow, preventing healing and increasing pain in the area. A vicious cycle of spasm and fissure may develop, which may require surgical intervention.

If not treated, anal fissures increase the risk of infection. Infected fissures cause severe pain, swelling, and inflammation. These abscesses can develop into anal fistulas, a more serious complication.

Anal fistulas arise from infected abscesses and cause an abnormal connection between the anus and the surrounding skin. Fistulas usually require surgical intervention.

Scar tissue caused by chronic fissures can narrow the anal canal. This leads to difficulty in defecation and severely impairs quality of life.

Persistent pain and discomfort due to untreated fissures can lead to fear of defecation. This can cause stool withholding, increased constipation, and restriction of the patient’s social life.

When Can Anal Fissure Treatment Be Performed?

Treatment planning for anal fissure depends on the severity of the symptoms, duration of the fissure, and response to conservative treatments. Acute fissures often heal spontaneously within a few weeks, but treatment should be started to relieve symptoms and accelerate healing. The aim is to improve the patient’s quality of life, control pain, and prevent recurrence.

Acute fissures can usually be managed successfully with dietary changes to soften the stool, sitz baths, and topical analgesics. These methods should be continued until complete healing, even if symptoms decrease within the first weeks. If pain, bleeding, or discomfort persists, pharmacological treatment options may be considered.

Anal fissures lasting more than three weeks are classified as chronic and usually require more intensive treatment. In cases where conservative methods are insufficient, pharmacological treatments such as topical nitrates or calcium channel blockers are used. These treatments lower sphincter pressure, increase blood flow, and support healing. However, these medications may have side effects, and patients should be informed accordingly.

If healing is not achieved despite conservative and pharmacological methods, surgical interventions should be considered. Lateral internal sphincterotomy (LIS) is one of the most effective methods for chronic anal fissures. This procedure reduces pressure by cutting a part of the internal sphincter and promotes healing. Transition to surgical intervention should be determined by a thorough evaluation with the patient. Other surgical options such as Botox injections or fissurectomy may also be planned according to patient needs.

When Is Anal Fissure Treatment Contraindicated?

Each of the methods used in the treatment of anal fissure should be carefully evaluated according to the patient’s general health status and medical history. In some cases, certain treatment methods may be contraindicated and should be avoided for patient safety and treatment success. The following are situations in which specific treatments should not be used:

• Topical Nitroglycerin Use:

Nitroglycerin ointment supports healing of fissures by reducing anal sphincter pressure. However, this treatment should not be used in patients with nitrate allergy, a history of severe anemia or hypotension, increased intracranial pressure, or those using phosphodiesterase inhibitors (such as sildenafil). In these cases, the medication may cause serious side effects.

• Calcium Channel Blockers:

Topical diltiazem or nifedipine relaxes the sphincter muscle. However, these medications should not be used in patients with low blood pressure (hypotension), a history of severe bradycardia or heart block, or allergy to calcium channel blockers. Incorrect use may increase the risk of cardiovascular complications.

• Botox Injections:

Botulinum toxin, used for temporary paralysis of the anal sphincter, should not be used in patients with toxin allergy, neuromuscular diseases (such as myasthenia gravis), or those with infection at the injection site. Otherwise, complications may develop.

• Lateral Internal Sphincterotomy (LIS):

Surgical reduction of sphincter pressure with LIS is not recommended in cases of active infection (such as perianal abscess), in patients with fecal incontinence, or those with a complicated history of anorectal surgery. Surgery may cause undesirable results in such cases.

• Fissurectomy:

Fissurectomy, which involves surgical removal of the fissure, is not recommended in patients with slow healing processes such as diabetes or immunosuppression, in the presence of infection, or in those at risk of incontinence.

What Is the Healing Process After Anal Fissure Treatment?

Lateral internal sphincterotomy (LIS) used in anal fissure treatment is generally a safe and effective surgical method. The postoperative healing process depends on both the success of the surgery and the patient’s adherence to lifestyle changes. There are several important points to consider to support recovery.

LIS is usually performed as a day procedure, and patients are generally discharged on the same day. Mild pain may be experienced after surgery, but prescribed painkillers control this well. Most patients notice immediate relief of fissure-related pain after surgery.

Hygiene and cleanliness of the surgical area are critical in reducing the risk of infection. Patients are advised to gently clean the anal area with warm water after bowel movements. Avoid harsh soaps and irritating products. Sitz baths help relieve discomfort and speed up healing.

It is essential to soften the stool to reduce pressure on the surgical site. A high-fiber diet, plenty of fluids, and stool softeners if necessary are recommended. Patients should avoid straining during defecation.

Postoperative pain is usually mild and easily controlled. Paracetamol or NSAIDs are sufficient for most patients. Stronger painkillers are rarely needed.

Patients can return to light activities soon after surgery. However, heavy lifting and intense physical activities should be avoided. Activities that may traumatize the anal area should also be avoided.

Attendance at follow-up appointments is important for a successful recovery. The success rate of LIS is high, but patient selection and regular follow-up are key for long-term safety.

How Can Anal Fissures Be Prevented?

Anal fissures can often be prevented with lifestyle changes and proper precautions. The first step is dietary adjustments to maintain bowel health. Consuming fiber-rich foods softens stool, regulates bowel movements, and reduces strain in the anal region. It is important to include fruits, vegetables, whole grains, and legumes in daily meals. In addition to fiber intake, drinking enough water maintains stool consistency and minimizes constipation risk. Adults are recommended to drink at least 8-10 glasses of water per day.

Regulating bowel habits is another effective step in preventing fissure formation. Excessive straining during defecation should be avoided, and one should go to the toilet promptly when the urge arises. Delaying can cause stool to harden and increase straining. Developing a regular toilet habit by accustoming the body to a routine will also be beneficial.

Regular physical activity supports bowel function and reduces constipation risk. At least 150 minutes of moderate exercise per week is recommended. Exercise not only supports bowel movements but also improves overall health.

Another important point is to avoid prolonged sitting on the toilet, as it increases pressure in the anal region and predisposes to fissure formation. During cleaning, the area should be cleaned gently, and harsh soaps that may irritate the skin should be avoided.

Underlying problems such as chronic diarrhea or constipation should be addressed. Bowel movements can be regulated by using stool softeners or laxatives as recommended by a doctor. To protect the anal tissues, avoiding trauma and prioritizing stress management are also among the preventive measures.

Türkiye’nin En İyi Anal Fissür (Makat Çatlağı) Yapan Doktorlara Sahip Olmasının Nedenleri

• Genel cerrahi alanında uzman hekimler: Türkiye’de göbek fıtığı (umbilikal herni) cerrahisinde deneyimli, laparoskopik ve açık cerrahi konusunda uzman birçok doktor bulunmaktadır.
• Modern cerrahi teknikler: Laparoskopik (kapalı) yöntemler, ağrıyı azaltan ve iyileşmeyi hızlandıran özel yama teknikleri (mesh) yaygın olarak kullanılmaktadır.
• Yüksek başarı ve düşük komplikasyon oranı: Ameliyat sonrası nüks (tekrarlama) oranı düşüktür; enfeksiyon ve komplikasyonlar nadirdir.
• Hızlı tanı ve planlama: Muayene, görüntüleme ve ameliyat süreci hızlı ve organize şekilde ilerler.
• Donanımlı cerrahi merkezler: Hem kamu hem özel hastanelerde teknolojik açıdan güçlü ameliyathaneler ve sterilizasyon sistemleri mevcuttur.
• İyileşme sürecinin yakından takibi: Ameliyat sonrası kontroller düzenli yapılır; hastaya özel beslenme ve hareket önerileriyle iyileşme desteklenir.
• Erişilebilir sağlık hizmeti: Gelişmiş cerrahi hizmetler, birçok ülkeye kıyasla daha ekonomik fiyatlarla sunulmaktadır.

Ortalama Anal Fissür (Makat Çatlağı) Fiyatları Ne Kadar ?

Ortalama Anal Fissür (Makat Çatlağı) fiyatları hastanın durumuna, cerraha ve ameliyatın yapılacağı ile ( İstanbul, İzmir, Ankara vb) değişiklik gösterebilir.

Anal Fissür (Makat Çatlağı) Yaptıranların Yorumları

Dr. Ahmet Bekin'in hasta yorumları için Google Maps'e göz atabilirsiniz.

Türkiye'de Anal Fissür (Makat Çatlağı) Yapan Doktorlar & Hastaneler

Anal Fissür (Makat Çatlağı) Türkiye'de genel cerrahlar tarafından uygun alt yapıya sahip özel hastanelerde ve devlet hastanelerinde yapılır.

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Frequently Asked Questions

How long does an anal fissure surgery take?

Anal fissure surgery, especially lateral internal sphincterotomy (LIS), usually takes around half an hour. The procedure is mostly performed under general anesthesia, and patients can return to daily routines within a week. Your doctor will determine the surgical method based on the location and severity of the fissure.

Which department/doctor should you see for an anal fissure?

Anal fissure presents with severe pain, burning, or bleeding due to cracks in the anal region. Discomfort usually increases during and after toilet use, negatively impacting daily life. Starting appropriate treatment without delay reduces the risk of chronicity. The most appropriate department for anal fissure problems is General Surgery. After examination, medication, cream, or surgical intervention may be required.

What is the recommended lying position after anal fissure surgery?

It is generally recommended to lie on your side after surgery, as this reduces pressure on the operation area and relieves pain. You can use a soft pillow or cushion for comfort during the recovery period. Following your doctor’s recommended position changes and care instructions will be very beneficial for pain management and wound healing.

How many days of hospitalization are required after anal fissure surgery?

Lateral internal sphincterotomy is mostly performed as a day procedure, and the patient can usually be discharged on the same day. In some cases, an overnight stay may be required as a precaution. Using prescribed medications regularly and following hygiene rules ensures a comfortable recovery.

What happens if anal fissure surgery is not performed?

Many anal fissures heal spontaneously or with lifestyle changes, but they can become chronic. If untreated, severe pain, bleeding, and rarely, infection may occur. In some cases, fissures may develop into fistulas and require more complex surgical intervention. If you have persistent symptoms, you should definitely consult a doctor.

What should be avoided after anal fissure surgery?

Avoid heavy lifting and make sure not to become constipated. Prolonged sitting on hard surfaces can put pressure on the wound area, so take frequent breaks or use a soft cushion. Eating spicy and hot foods may cause discomfort during toilet use. Also, avoid sexual activities not approved by your doctor.