Chronic constipation and a fissure — treating the root cause, not just the tear

This patient's story is one Dr. Refaai sees often: a fissure that would heal for a while and then return, each flare bringing pain on passing stool and a little bleeding. Previous treatment had focused on the tear itself, but the fissure kept coming back — a strong sign that something upstream was driving it.

Assessment pointed clearly to chronic functional constipation as the root cause. Hard, infrequent stools and straining were repeatedly re-injuring the same area, so any treatment aimed only at the fissure was always going to be undermined by the bowel pattern behind it. Dr. Refaai's approach deliberately treats the surgical problem and its cause as two connected stages rather than one.

The fissure itself was treated with an appropriate, measured intervention to help the tear heal and to relieve the muscle spasm that keeps chronic fissures open. But this was framed as one half of the plan, not the whole of it.

The other half — and the reason the earlier treatments had not lasted — was a root-cause, functional-medicine-informed plan for the constipation. Drawing on his training in applying functional medicine, Dr. Refaai worked with the patient on fibre, fluid intake, meal timing, activity and toileting habits, adjusting stool softness so that passing a bowel movement no longer re-tore the healing tissue.

Progress was gradual, as it usually is when the goal is a genuinely regular bowel pattern rather than a quick fix. Over several weeks the stools normalised, straining eased, and the fissure was finally given the stable conditions it needed to heal and stay healed.

In this case the fissure healed and bowel habits became regular. Because constipation has many contributing factors and every patient is different, this is shared as an illustrative example of the root-cause philosophy rather than a guaranteed outcome, and any plan is tailored individually.