Causes of Failure in Anal Fissure Treatment

An anal fissure is a distressing health condition that causes severe pain and bleeding in the anal area.
While many patients heal quickly with appropriate treatment, in some cases symptoms may persist despite medical intervention.

So why does anal fissure treatment fail?
When should the treatment be reassessed?
We examine all these questions in detail.

What Is an Anal Fissure?

An anal fissure is a small tear in the skin around the anus.
It has two types:

Acute Anal Fissure: Recently formed, superficial tears. Respond better to treatment.
Chronic Anal Fissure: Long-lasting fissures with skin folds and deepening at the edges.

If not correctly diagnosed or if treatment is delayed, the fissure may become chronic and harder to heal.

Causes of Treatment Failure in Anal Fissure

Several key factors may lead to treatment failure:

Incorrect or Incomplete Diagnosis

Sometimes the fissure may be misdiagnosed as another condition (e.g., anal fistula, cancer).
Underlying systemic conditions (e.g., Crohn’s disease) can impair healing.

Inadequate or Improper Treatment Selection

Advanced chronic fissures are difficult to resolve with cream treatment alone.
Improper botox injection technique may fail to provide sufficient relaxation.
Laser or surgical treatments applied to the wrong candidates may result in recurrence.

Poor Patient Compliance

Ignoring dietary habits, water intake, and toilet routines may cause recurrence.
Discontinuing supportive care like sitz baths can delay healing.

Effect of Underlying Diseases

Inflammatory bowel disease
Immune system disorders
Diabetes or other healing-impairing conditions

These cases require special treatment strategies.

Post-Treatment Hygiene and Care Errors

Poor hygiene of the anal area
Prolonged sitting or continued straining
Skipping regular doctor check-ups

All these factors may contribute to treatment failure.

How to Recognize Failure?

If symptoms persist despite treatment, failure is likely:

Continued pain during or after bowel movements
Post-defecation bleeding
Unhealed open wound near the anus
Repeated fissure formation

If any of these occur, advanced evaluation is necessary.

Which Treatments Are More Likely to Fail?

Conservative Treatments

Advanced cases treated only with creams and suppositories often have lower success rates.

Incorrect Botox Applications

Inadequate dosage or wrong injection points lower effectiveness.

Inadequate Surgical or Laser Applications

Poor technique in laser or surgery may lead to recurrence or complications.

What to Do After Treatment Failure?

Advanced Evaluation

A proctology specialist should conduct a thorough physical and possibly endoscopic examination.

Investigate Underlying Conditions

Rule out systemic causes like Crohn’s disease, cancer, tuberculosis.

Personalized Advanced Treatment Options

Combination therapy (e.g., laser + botox) may be planned.
If necessary, minimal surgical procedures can be performed.

👉 At Avrupa Cerrahi, this process is managed with a multidisciplinary approach.

Approach to Failed Fissure Treatment at Avrupa Cerrahi

At Avrupa Cerrahi, we:

Take a thorough patient history and perform detailed examination
Use modern laser systems and precise botox techniques
Develop personalized treatment protocols
Provide close follow-up and support during recovery

Frequently Asked Questions (FAQ)

Why does anal fissure treatment fail?
Incorrect diagnosis, inappropriate treatment method, or poor patient compliance can all contribute.

What if the fissure doesn’t heal after botox?
Further evaluation is done; laser treatment or surgery may be planned if needed.

Could a non-healing fissure be a sign of cancer?
Rarely, yes — especially in chronic cases, anal cancer should be ruled out.

Causes of Failure in Anal Fissure Treatment