Thank you for consulting with Doctorspring. I understand that you have been worried about anal fissure which you think has become chronic causing pain and discomfort. It has also left you confused as to which surgery to opt for. Fissure is a common surgical problem but only 10-15% of patients actually need surgery and benefit form it. I'd like to know what your doctor prescribed before you were told that you may need surgery. I still think that a trial of no surgical methods would help you. Surgical procedures are generally reserved for people with anal fissure who have tried medical therapy for at least one to three months and have not healed.

Firstly, try taking more fibre in your diet including fresh fruit, oat bran, and porridge. Increase your intake of water and try to walk at least for 10 to 15 mins after every meal. You could try Regulan (isphagula husk) and follow the instructions on the carton.

Secondly, to relieve pain, a local anaesthetic cream could be tried. This is safe even if you are breast feeding.

Thirdly, you could try Diltiazem 2% ointment. It has to be applied into the anus with the help of a disposable glove. This should be continued for 2 times a day for 8 weeks. Some people get a headache with this which will go away if you take an analgesic like Paracetamol.

Also, you could try taking Sitz baths with warm water and salt with about 3 ml of Savlon. Keep your anal areas clean using wet wipes every time you have to use the bathroom.

If all this has failed, the next step is surgery. Lateral sphincterotomy is performed mainly because of the ease of the procedure itself. But nearly 40% of patients suffer form some degree incontinence of flatus and when you get diarrhea. A V-Y flap basically covers up the defect caused by the fissure. A newer procedure which has met with considerable success is a combination of Botox injection and VY surgery. The Botox paralyses the muscle of the anal canal allowing for temporary healing.

I would suggest that you bring up these issues with your surgeon and ask him whether you could have a trial of non-surgical management and discuss with him the option of Botox with VY plasty. I hope this information is useful to you.