An anal fissure — a small tear in the lining of the anal canal — causes one of the most disproportionately painful symptoms in proctology. Patients describe a sharp, tearing pain during defecation followed by a burning ache lasting minutes to hours. When a fissure becomes chronic (lasting more than 6–8 weeks), it often develops a sentinel tag — a fibrous skin growth at its external margin that acts as a permanent marker of the inflammation beneath.
Why Does a Sentinel Tag Form?
Chronic fissures create a vicious cycle: pain triggers internal anal sphincter spasm → spasm reduces blood supply to the fissure → poor healing → more inflammation → repeated tearing. The sentinel tag forms from repeated oedema and fibrosis at the fissure's external edge. It is not dangerous, but it perpetuates the inflammatory cycle and makes hygiene difficult — patients often mistake it for a pile.
Grading Your Fissure: Choosing the Right Path
Fresh tear, <6 weeks
Ayurvedic ointments + sitz bath + dietary fibre. Heals in 80% of cases without any procedure.
6+ weeks, exposed fibres
Ksharakarma or botulinum injection to break the sphincter spasm cycle and promote healing.
Fibrotic, non-healing
Minor surgical tag removal + lateral internal sphincterotomy (LIS) under LA. Day procedure.
The Sentinel Tag Removal Procedure
When a sentinel tag is present alongside a chronic fissure, it must be removed at the same time as the fissure is treated — leaving it behind allows re-infection and delays healing. At Yathartham Shalyaveda, we perform this as a combination procedure:
- Step 1 — Local anaesthesia: A perianal nerve block is performed in the outpatient procedure room. No general anaesthesia is required.
- Step 2 — Tag excision: The sentinel tag is excised cleanly at its base using a fine diathermy current, leaving no raw wound.
- Step 3 — LIS (Lateral Internal Sphincterotomy): A controlled, partial division of the internal sphincter is made laterally (away from the fissure) to relieve chronic spasm. Only a fraction of the sphincter is divided — continence is fully preserved.
- Step 4 — Ayurvedic wound care: Jatyadi oil-soaked gauze is applied to the wound bed. Patients are sent home within 2 hours.
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The post-procedure protocol is as important as the surgery itself for preventing recurrence:
- Sitz bath: Warm Panchavalkala decoction sitz bath for 15 minutes, twice daily for 4 weeks
- Local application: Jatyadi Taila on the wound bed after each sitz bath
- Oral medicines: Triphala Churna at bedtime to ensure soft stools; Avipattikar Churna for Pitta control
- Diet: High-fibre, warm, well-cooked foods; 2.5–3 litres water daily; no spicy, fried or cold food for 6 weeks
Frequently Asked Questions
The procedure is performed under local anaesthesia, so you feel no pain during the surgery. Post-procedure discomfort is mild — comparable to a papercut — and is managed with simple oral analgesics for 2–3 days.
No. The lateral internal sphincterotomy divides only a very small portion of the internal sphincter — the muscle responsible for resting tone only, not voluntary continence. Urgency or incontinence is not a risk when the procedure is performed correctly by an experienced proctologist.
Most patients return to desk work within 24–48 hours. Physical or outdoor labour should be avoided for 7–10 days. Full healing of the wound takes 4–6 weeks.
Recurrence after LIS is under 2% in expert hands. Maintaining a high-fibre diet, adequate hydration and avoiding constipation are the key long-term preventive measures.
Struggling with this condition?
Dr. Piyush Ranjan Padhi offers personalised consultations in Balasore, Bhadrak, Bhubaneswar and online.
Book a Free Consultation →