Anal Fissure Treatment in Moscow: Acute and Chronic Fissure

Overview

Message Dr. Tatarinov directly on WhatsApp or Telegram in English — he replies personally.

A fresh (acute) fissure often heals with soft stools and local treatment.
A fissure that lasts for months becomes scarred and usually needs excision.
I remove chronic fissures with a laser; the type of anaesthesia depends on the case.

Dr. Tatarinov's English is basic; a consultation in English is possible.

Signs of an anal fissure

An anal fissure is a small longitudinal tear in the lining of the anal canal. People describe it as passing broken glass: a sharp, burning pain during a bowel movement that can last for minutes or hours afterwards. A few drops of bright red blood on the paper are common. Many patients start to put off going to the toilet because of the pain, the stool becomes harder, and the tear opens again.

Pain and bleeding are not specific: hemorrhoids, an abscess or a tumour can look similar from the patient's side. A diagnosis is made only in person.

Acute or chronic?

	Acute fissure	Chronic fissure
Duration (guide)	Up to 4–6 weeks	Over 6–8 weeks, or keeps reopening
Appearance	Fresh tear with soft, even edges	Firm scarred edges, often a sentinel skin tag and an enlarged anal papilla
Pain	Sharp, with every bowel movement	Comes in waves; flares after constipation or travel
Usual approach	Soft stool, hygiene, treatment prescribed by a doctor	As a rule, an operation

Why a fissure may not heal

The anal canal has many nerve endings, so a tear hurts. In response, the internal sphincter muscle tightens and stays in spasm. A tight muscle squeezes the small blood vessels, the wound gets less blood and heals poorly, which keeps the pain going. Over time the edges turn into scar tissue, and new lining does not grow over a scar. Hard stools and straining injure the same spot again. This is why changing one cream for another rarely helps once the fissure has become chronic.

Treatment

Conservative treatment

For an acute fissure, or one on the border between acute and chronic, the plan is to break the cycle of pain and spasm:

soft, regular stools: water, dietary fibre and, if needed, a stool softener;
rinsing after a bowel movement instead of dry paper;
warm sitz baths to relax the sphincter;
topical medicines that reduce spasm and support healing, prescribed after the examination.

I agree a control visit in advance. If there is no improvement, we do not wait for months but discuss surgery.

Laser excision of a chronic fissure

The operation removes the scarred tissue and deals with the spasm so the wound can heal. I excise the fissure within healthy tissue, together with the sentinel tag and an enlarged papilla if they are present; the laser cuts and seals small vessels at the same time. If the sphincter spasm is severe, botulinum toxin may be injected during the operation. Anaesthesia is general or local depending on the case, and you usually go home on the same day. The energy source is chosen individually, since the laser is not suitable for everyone.

Fissure together with hemorrhoids

The two often occur together. When both need surgery, they can usually be treated in a single procedure; read more on the hemorrhoid treatment page.

Has the pain been going on for weeks?

Write to me in English and describe how long it has lasted. We will find a time for an examination at one of the two Moscow clinics.

WhatsApp Telegram +7 926 446-57-79

There are contraindications; a specialist consultation is required.

After the operation

Recovery after fissure surgery is usually easier than after hemorrhoid surgery, and for many patients the pain while healing is no stronger than the pain they had before. You receive a written home-care plan: how to keep stools soft, how to care for the wound, which pain medicines to take and when to contact me.

The first three days: rest at home.
About ten days: back to office work.
Two weeks: swimming pool. Three weeks: sport.
Four to six weeks: the wound heals, sometimes longer.

I check the wound weekly at first, then every two weeks. Contact me straight away if bleeding increases, pain grows instead of easing, a fever appears or you cannot empty your bowels.

A fissure can come back if the old triggers return, so after healing it helps to keep the habits: soft stools, no straining, and not sitting on the toilet for long.

Consultation fee

4 500 ₽ — first visit in Moscow

Covers the examination, anoscopy if required and a treatment plan. Prices for laser excision are on the price page (in Russian); the exact sum is named after the examination.

Where: H-Clinic, 6A bld. 1, 8 Marta St. (near Dinamo metro), or MedEx, 34/14 bld. 7, Kutuzovsky Ave. (near Kutuzovskaya metro). The surgeon you meet at the consultation is the one who operates and follows your recovery. About Dr. Tatarinov and the consultation.

Do not wait for an appointment if

swelling, redness and throbbing pain near the anus are growing, with fever: this can be an abscess;
bleeding is heavy, the stool is black, or you feel weak or dizzy.

Call 103 or 112.

Frequently asked questions

How can I tell whether my fissure is acute or chronic?

Only an examination shows it reliably. As a rough guide, a fissure that has not healed for more than 6–8 weeks, or keeps reopening, is likely to be chronic, especially if a small skin tag has appeared next to it.

Can a chronic fissure heal without surgery?

Sometimes, if it is on the border between acute and chronic and there are no scars yet; then a supervised course of conservative treatment is worth trying. A fissure with firm scarred edges and a sentinel tag usually does not heal with creams alone, and excision is discussed.

How is laser excision performed?

Under general or local anaesthesia, depending on the case. The fissure is removed within healthy tissue together with the scarred edges, the sentinel tag and an enlarged papilla if present. Patients usually go home 1.5–2 hours after the procedure.

How long is recovery after fissure surgery?

As a guide: 3 days of rest at home, desk work after about 10 days, swimming pool after 2 weeks, sport after 3 weeks, and wound healing in 4–6 weeks, sometimes longer.

I have both a fissure and hemorrhoids. Do I need two operations?

Not necessarily. When both problems need surgery, they can often be treated in one procedure. This is decided after the examination.

How do I book, in which language, and what does the first visit cost?

Message me on WhatsApp or Telegram at +7 926 446-57-79; writing in English is welcome. Dr. Tatarinov's English is basic; a consultation in English is possible. The first visit in Moscow costs 4 500 ₽ and includes anoscopy when needed.

Is foreign insurance accepted, can I pay with a foreign card, and will I get a report in English?

Please ask Dr. Tatarinov in the messenger before booking.