Q: My father has been diagnosed to have a painful crack in the internal lining of anus or fissure in ano. What is the difference between anal dilation and internal sphincterotomy as techniques of surgery; which of these is commonly done and which gives better results? Is any other method (surgical or otherwise) of treating anal fissures available in India, if so which centres/cities have the facility? I am told that surgery in such cases is stitchless i.e. the tear is not sewed and the chances of post-operative infection are large. What sort of post-operative care can prevent this and what needs to be done, what ointments or medicines can cure faster? My resrearch on the Internet has brought to my knowledge that a certain nifedipine ointment with a success rate of 95% is used to cure chronic anal fissures. Is this ointment available in India, and is its use recommended? My father is hypertensive and does not have diabetes.

A:Your father has an anal fissure. Initial treatment is by Sitz baths and laxatives. I presume you father has tried these. Standard treatment in failed conservative treatment is surgery. Fissure healing is hindered by the tone of the anal muscle. Anal dilatation tears the anal muscle, weakens it, and allows the fissure to heal. Sphincterotomy cuts the muscle, weakens it, and allows the fissure to heal. Both anal dilatation and sphincterotomy have similarly good results, and the choice is best left to your surgeon. Some persons may offer thread therapy. Do NOT accept for fissure. Thread therapy is good for a fistula, which is a different disease. Some creams are available. Botulinus injections have been tried. These are experimental therapies, and do not represent standard treatment. At 52 years of age your father can take minor surgery easily.