Anal fissures and fistulas are painful anorectal conditions that can significantly affect daily comfort and bowel habits. Anal fissures are small tears in the lining of the anal canal, often caused by hard stools, constipation, or trauma during bowel movements. Anal fistulas are abnormal tunnels connecting the anal canal to the surrounding skin, usually resulting from infection or abscess formation.

Patients with fissures typically experience sharp pain during and after bowel movements, bleeding, and spasm of the anal muscles. Fistulas may cause persistent discharge, swelling, recurrent infections, and discomfort. Chronic cases can lead to ongoing pain and repeated infections if not treated appropriately.

Diagnosis is based on clinical examination, with imaging such as MRI or endoanal ultrasound used in complex fistula cases to map the tract accurately.

Initial management of fissures includes dietary changes, stool softeners, topical medications, and warm sitz baths. When conservative treatment fails, surgical options such as lateral internal sphincterotomy may be recommended to promote healing.

Fistulas usually require surgical treatment, including fistulotomy, seton placement, or advanced sphincter-preserving techniques depending on complexity. At IMH, procedures are planned carefully to preserve continence, reduce recurrence, and promote rapid healing.