Yes, he needs Surgery.

In case it is a chronic form (>6 min), it is a simple surgery with excision.

It is best to first change his diet. He must have a high-fiber, low-fat diet that contains 90 oz of water daily. This will provide soft stool to prevent anal fissures. Treatment for the fissure includes sitting in baths to help with healing and pain. Lidocaine jelly and proctofoam is commonly used to ease discomfort and pain. Fissures that do not heal will require surgery to remove the fistula and allow for healing by secondary intent.

The classic treatment for this condition is a surgical procedure called anal sphincterotomy, which splits the internal anal sphincter and relaxes that muscle so the fissure can heal. Recently, Botox injections have been used to accomplish the same effect, which greatly decreases discomfort and healing time. You need to discuss this with a colon/rectal surgeon to get the best recommendation.

Joseph E. Ronaghan, MD, FACS, FICS

Yes. Later interval sphincterotomy (lis). I’d try six weeks of fiber therapy before I proceeded with surgery.

First, he needs an exam to make sure it’s a fissure and not something else. If it is a fissure, then he needs to be checked for underlying causes. This usually includes a colonoscopy. There are 2 main approaches. One is to do the least to get it to heal, which may involve diet and bowel habit changes, several different medications, and procedures over a prolonged time.The other is to do the most effective treatment right up front, which is a surgery called a lateral internal sphincterotomy. Works well, but up to 5% have some degree of incontinence. In my practice, I take the minimalist approach.

Surgery could be the last option. Botulinum A toxin injections are usually used when medicines such as diltiazem cream haven’t worked. They relax your internal sphincter muscle to help healing. The injections may last for around three months. They may cause some side-effects, such as muscle weakness, but this should be temporary. Around one in every two anal fissures come back within a year after the injections.

Sphicteromy or nitroglycerin cream. Seitz bath after BM. Anal wipes should be used after cleaning anal area.

Yes

It is a general understanding that fissures that have been treated with stool softeners and anti-spasmotics for 2-3 month with no improvement should be treated with surgery. It (generally) will eliminate the pain. There is a 5% risk of "incontinence" of some sort. Usually only temporary but it can require remedial surgery.