Concierge colorectal · London
Anal fissure surgery - private in London.
An anal fissure is a small tear in the anoderm that causes sharp, knife-like pain during and after bowel motions, often with bright red blood on the paper. Most heal with creams. When they do not, Botox injection or a lateral internal sphincterotomy in a day-case unit ends the pain and heals the fissure in over 95% of cases.
Why patients choose us
- 01
A subspecialty consultant
A UK colorectal consultant matched to your case, not a generalist on a list.
- 02
Booked in days, not weeks
Weekday, evening and weekend slots across London and the major UK cities.
- 03
Independent, and free
We take no fee from clinics, so the recommendation is impartial and costs you nothing.
What it is
A small tear that will not let up.
An anal fissure is a linear tear in the anoderm, the sensitive lining just inside the anus. Most sit in the posterior midline. They are caused by a hard or explosive stool that splits the lining, and they persist because the exposed internal sphincter goes into spasm, which cuts blood flow and stops the tear from healing.
An acute fissure is under 6 weeks old and usually heals with fibre, water and topical creams. A chronic fissure has been present for more than 6 weeks, often with a sentinel skin tag at the outer end and a hypertrophied anal papilla at the inner end. Chronic fissures need something to break the spasm cycle: Botox, or surgical division of a small piece of the internal sphincter.
The condition is common, benign and highly treatable. The pain, however, is disproportionate to the size of the tear and can dominate daily life.
Symptoms
Sharp pain, then hours of aching.
- Severe knife-like pain on defecation that lasts for minutes to hours afterwards, often described as passing broken glass.
- Bright red blood on the toilet paper, small volume, clearly linked to the bowel motion. Never mixed into the stool.
- A cycle of pain, fear of the toilet, constipation and harder stool that then splits the fissure open again.
- Anal spasm so tight that a routine examination is often not tolerated without local anaesthetic.
- Occasional itch or a palpable skin tag at the anal verge in chronic cases.
Indicative pricing
What private anal fissure surgery costs in London.
Indicative all-inclusive ranges across our partner units. Send the details and we quote firm figures across two or three options, with cover checked.
In short
Botox £1,400–£2,200. LIS £3,500–£5,500. Advancement flap £4,500–£7,500.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Botox injection (internal sphincter) | £1,400–£2,200 | 10 min | Day case |
| Lateral internal sphincterotomy (LIS) | £3,500–£5,500 | 15 min | Day case |
| Fissurectomy + advancement flap | £4,500–£7,500 | 30–60 min | Day case or overnight |
| Consultant consultation | £200–£400 | 30–45 min | Same visit |
| Follow-up review | £150–£300 | 20–30 min | Same visit |
Prices vary by hospital, by consultant and by the complexity of your case. All figures include GA, day-unit stay and consultant fees.
The problem
The right anal fissure treatment, at the right time.
NHS pathways work but the wait is long, and by the time it is offered the fissure is often deeply chronic. Private care shortens the timeline and lets you choose the consultant.
-
NHS waits are long
Colorectal outpatient waits stretch beyond 12 weeks in many trusts. Private care shortens this to days.
-
The right consultant matters
Fissure outcomes track with subspecialty interest, not just hospital brand. A tailored partial sphincterotomy protects continence.
-
Insurer processes are opaque
We handle preauth, coding and any second-opinion requirements on your behalf.
The journey
From enquiry to follow-up - what happens, in order.
One team from first message through procedure and follow-up.
- 01
Before
Send us your history
Symptoms, prior creams tried, bleeding pattern, any letters.
- 02
Before
Match to a consultant
A colorectal consultant with a specialist fissure interest.
- 03
Before
Preparation instructions
Fasting, medication and consent guidance ahead of the day.
- 04
On the day
The procedure
Botox injection or lateral internal sphincterotomy under GA in a CQC-registered day unit.
- 05
On the day
Same-day discharge
Nursing observation before discharge with written aftercare.
- 06
After
Report and results
Consultant report the same day, sent to you and your GP with your consent.
- 07
After
Follow-up and plan
Wound and continence review at 4 to 6 weeks.
When it helps
When anal fissure surgery is the right step.
Situations where a procedure is a reasonable next step after conservative measures.
-
Chronic fissure over 6 weeks
Creams failed, still bleeding and in pain.
-
Severe knife-like pain on stool
Cycle of pain-avoidance-constipation.
-
Bright red blood on paper
Small volume, clearly linked to defecation.
-
Anal spasm on examination
Tight, tender internal sphincter.
-
Recurrent fissure after healing
Consider Botox or LIS as next step.
Treatment ladder
The steps, in order.
Start conservative, escalate only if the fissure will not heal. Every rung protects the sphincter more than the next.
-
Topical creams
GTN 0.4% or diltiazem 2% for 6 to 8 weeks. First-line for most.
-
Botox injection
20 to 50 units into the internal sphincter. Sphincter-preserving, day case.
-
Lateral internal sphincterotomy
Gold standard for chronic refractory fissure. Small partial cut, healing above 95%.
-
Fissurectomy + advancement flap
For posterior fissures, previous LIS or high incontinence risk.
Botox injection
A day-case, ten-minute procedure. 20 to 50 units of botulinum toxin injected into the internal anal sphincter under short GA or heavy sedation. Chemical relaxation of the sphincter lasts around 3 months, long enough for the fissure to heal in 60 to 70% of patients. No permanent sphincter change and no incontinence risk. Can be repeated.
Lateral internal sphincterotomy (LIS)
The gold standard for chronic refractory fissure. A 15-minute day-case operation under GA. A small, calibrated partial cut is made in the lower fibres of the internal sphincter through a 1cm lateral incision, breaking the spasm cycle. Healing rate above 95%. Minor flatus incontinence in 5 to 10%. Same-day discharge.
Fissurectomy + advancement flap
The sphincter-sparing alternative. Reserved for posterior fissures with a large sentinel pile, patients who have already had a LIS, and those at high incontinence risk (previous obstetric injury, IBD, low resting pressure). The fibrotic edges are excised and a flap of healthy anoderm advanced over the defect.
Where it is done
A small panel of London colorectal units.
We match you to a consultant with a subspecialist fissure interest at one of the following centres. Introductions are made privately, once we understand your case.
-
London Colorectal Clinic
-
HCA London Bridge Hospital
-
The London Clinic, Harley Street
-
Cromwell Hospital (Bupa Cromwell)
-
Nuffield Health Bushey
-
The Princess Grace Hospital
-
CQC-registered UK day units across London and the major cities
-
Direct insurer preauth handling for Bupa, AXA, Vitality, Aviva, WPA and Cigna
Recovery and safety
What to expect afterwards - honestly.
Recovery after LIS is quick. Most patients are back at a desk in 1 to 2 days. Sitz baths, a high-fibre diet and stool softeners for 6 weeks. The fissure itself heals over 3 to 6 weeks.
-
Incontinence risk
5 to 10% minor flatus incontinence after LIS. Advancement flap avoids sphincter cutting.
-
Why creams fail
Poor compliance, headache from GTN, deep fissure or high resting sphincter pressure.
-
Botox effect
60 to 70% healing at 3 months. Temporary and reversible. Can be repeated.
-
Recurrence
5 to 10% after LIS, higher after Botox. Diet and stool softeners reduce recurrence.
-
Bleeding
Usually minor and self-limiting after LIS.
-
Time off work
1 to 2 days for desk work after LIS. Sitz baths and high-fibre diet.
Reading your notes
Your report in four parts. Read the last one first.
Whichever centre performs the procedure, the report keeps to the same shape.
- 01 Header
Indication and consent
Why the procedure was done, what was consented and any relevant history.
- 02 Findings
What was seen or done
Fissure location, depth, sphincter tone, technique used, units of Botox or length of sphincterotomy.
- 03 Assessment
Consultant interpretation
What the findings mean in your clinical context.
- 04 Impression
Summary and next step
Read this first. Bottom line, aftercare and recommended follow-up.
Recognised by major UK insurers
Usually covered by UK private medical insurance when there is a specialist referral and documented failure of medical therapy.
Frequently asked
Everything we get asked about anal fissure surgery.
-
What is the incontinence risk after lateral internal sphincterotomy?
Around 5 to 10% experience minor flatus incontinence or occasional soiling. Frank stool incontinence is rare, under 1% in modern series with a tailored partial sphincterotomy. Advancement flap is offered where risk is higher, for example previous LIS or obstetric injury.
-
Why did the GTN or diltiazem cream fail to heal my fissure?
Common reasons are poor compliance from headache with GTN, incomplete 6 to 8 week course, a deep chronic fissure with a sentinel pile, or persistently high internal sphincter pressure. Botox or LIS is the logical next step.
-
Does Botox really work for anal fissure?
Yes. 60 to 70% of chronic fissures heal at 3 months after a single injection of 20 to 50 units into the internal sphincter. It is a 10-minute day-case procedure with no permanent sphincter change, and it can be repeated.
-
What is the recurrence rate after anal fissure surgery?
After LIS, 5 to 10% recur, usually because of ongoing constipation. After Botox, recurrence is higher at 20 to 30%. A high-fibre diet, stool softeners and adequate hydration are essential.
-
Is anal fissure surgery covered by UK private medical insurance?
Usually yes with a specialist referral and a documented failure of medical therapy. Bupa, AXA, Vitality, Aviva, WPA and Cigna cover Botox injection, LIS and advancement flap under standard colorectal codes.
-
How long does it take to heal after LIS?
Pain relief is usually immediate as sphincter spasm settles. The wound heals over 3 to 6 weeks. Most patients return to desk work after 1 to 2 days. Sitz baths twice daily and a high-fibre diet speed healing.
Ready when you are
End the pain. Book anal fissure surgery in London this week.
Send us your history and we will match you to a colorectal consultant with a subspecialist fissure interest, quote firm figures across two or three London units, and handle insurer preauth on your behalf.
Related
Looking for something else?
-
Anal fistula surgery
LIFT, VAAFT, advancement flap.
Learn more -
Perianal abscess drainage
Urgent day-case incision and drainage.
Learn more -
Colonoscopy
Full lower GI assessment.
Learn more -
IBS
When bowel symptoms sit alongside the fissure.
Learn more -
All tests & procedures
Every test we arrange.
Learn more -
Conditions library
Guides for common conditions.
Learn more