The treatment options for this can be conservative where we can manage them with medications. Physiotherapy does go hand in hand with patients with pelvic floor fissures as patient’s do find ways of evacuating and trying to reduce the pain and sometimes pelvic floor physiotherapy with a dedicated specialist physiotherapist can help to normalise symptoms after successful treatment of the condition.

1. Medications including local creams and laxatives.
2. Botox injections – botox injections have proven to be very successful in treating fissures. I do undertake botox injections under local anaesthetic and general anaesthetic depending on the patient’s needs and suitability. Under local anaesthetic, I can undertake them during or soon after the first visit if necessary to avoid any delays with a general anaesthetic procedure.
3. Mucosal advancement flap – This procedure is carried out to bring a flap of skin to cover the defect as the fissure is a cut in the perianal region. This can include removal of a sentinel pile which is there as well.
4. Lateral sphincterotomy even though this is done very sparingly, prior to this procedure I do undertake anorectal physiology to assess the sphincter function and in females, we tend to try other procedures prior to offering this as a lateral sphincterotomy can cause damage to the sphincters and also affect continence in the long term.

I undertake all these procedures and I would be very happy to discuss your needs and also talk to you about management.