Doctors classify fissures based on Time (Acute vs. Chronic) and Depth. Knowing your grade helps decide between Medicine or Surgery.
A tear that is less than 6 weeks old. It looks like a fresh paper cut. The muscle is not exposed.
90% Heal with MedicinePersists for more than 6-8 weeks. The edges become thick and white (scar tissue). A skin tag often forms.
Surgery RecommendedA fresh, paper-cut like tear. Edges are clean and soft. There is severe pain but bleeding is minimal.
The tear exposes the internal sphincter muscle fibers. Edges become hard (fibrosed). Pain lasts for hours.
A hallmark of chronicity. A skin tag (Sentinel Pile) forms at the lower end of the tear. Often mistaken for hemorrhoids.
Associated with infection, abscess, or fistula formation. The tissue is infected and very painful.
Identifying the 'Sentinel Tag'
"Once a 'Sentinel Tag' appears, it's a sign the body has tried and failed to heal the wound naturally. This usually indicates Grade 3."
Dr. Jaya Maheshwari explains visually how to tell if your fissure has become chronic and why old fissures stop responding to ointments.
Applying creams on a Grade 3 (Chronic) fissure is often a waste of time because scar tissue prevents healing. Grading ensures you don't delay the right treatment.
