An anal fissure is a tear in the skin around the opening of the anus. Anal fissure is usually associated with pain and bleeding during bowel movements. Anal fissures are usually developing as result by increased tone of the anal muscles (anal sphincters) – a condition called hypertonia.

Anal fissures are diagnosed based on patient’s history, presentation, and symptoms. Physical examination is also important in confirming the presence of anal fissure.

Instrumental test called High resolution Anorectal manometry is performed in the office to confirm the presence of tightness of anal muscle (hypertonia) which is the underlying cause of anal pain and fissure. This test is performed in a dedicated room in the doctor’s office, and it requires insertion of small catheter in the anal canal, which registers with great accuracy the pressure of the anal canal. Test is not painful, and it is very well tolerated even in patient having anal pain and discomfort due to underlying the pathology. It last around 10’ with complete respect of the patient’s privacy

The information of the test is immediate available and discussed with the patient in the doctor’s office. Based on the results of the test and patient condition, proper treatment plan is discussed and agreed with the patient.



The aim of this information sheet is to provide an answer the most frequently asked question about Anal Fissure Surgery. Additional and detailed information on the technique of this procedure can be found in the Educational Video and Presentation in the website

Anal Fissure surgery is aimed to re-establish the conditions which lead to healing of the small mucosa tear, called fissure. Some of the procedures can be planned and done in stages and your doctor will explain how the entire sequence of surgery works and more detailed explanation can be found on the website in the Educational Video section.

In case of anal fissure associated to hypertonia of anal sphincters which was already explained above, the procedure of choice is to proceed to injection within Internal Anal Sphincter of Botulin Toxin to partially block the function of the muscle itself and therefore reducing the level of contraction (hypertonia). This procedure is very simple but to avoid discomfort and inconvenience to the patient is performed in OT under sedation. Endo anal US is utilized to guide injection of Botulin Toxin precisely into Internal Anal Sphincter. The entire procedures last maximum 5 minutes and patient is free to go home after minimal observation time on 2 hours.


  • What to expect after the procedure?
  • What activity would I be able to perform immediately after surgery?
  • What are the complications of this procedure?
What to expect after the procedure?

This procedure is safe no side effects are reported. Using Endo Anal US guidance also improve the accuracy of the injection and increases the success rate

Postoperative period is usually not painful, although some patient describes post-procedure anal soreness which is controlled with pain medication prescribed on discharge.

What activity would I be able to perform immediately after surgery?

Normal activity can be resumed immediately including also sports if patient feels well.

Follow up consultation is planned generally after 10 days. Effect of Botox is felt within to few days from the injection but in some patient, it may take longer the benefits.

What are the complications of this procedure?

Injection of Botulin Toxin in the Internal Anal Sphincter under US guidance is a safe and effective modality to treat hypertonia associated to anal fissure. Procedure is completely safe and not associated to any immediate and or long-term complication. Dr. Cristaldi initiated this kind of treatment 20 years ago at pioneer stage and he has gradually improved and refined the indications and the technique of this procedure. During the said period he has provided relief to anal hypertonia and anal fissure to more than 2000 patients without encountering significant complications related to this treatment modality.

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WED    10:00 – 18:00
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