Patients walk into my clinic and ask me the same question almost every week: “Doctor, kya yeh surgery painless hoti hai?” I want to give you an honest answer, not a marketing answer. The honest answer is more interesting than yes or no — and in this article I will tell you exactly what laser sphincterotomy feels like, before, during, and after, from a Karachi proctologist who has performed thousands of these procedures.
The short version: during the surgery itself, I make sure you feel nothing because you are under anaesthesia. The pain that actually matters is the post-operative pain — and that is where I believe laser sphincterotomy is dramatically better than the open surgery your father or grandfather might have had. In my experience most patients describe day-one pain as “much less than I expected” and are walking comfortably within 24 to 48 hours.
Why Patients Call Laser Sphincterotomy “Painless” — And What I Think It Really Means
I have to be straight with you: the word “painless” is marketing shorthand. I do not believe any real surgery is truly painless. Your body has nerves, surgery cuts tissue, healing involves discomfort. What I have seen patients mean when they call this surgery painless is something more specific — the pain is so much lower than what they were braced for that it feels like nothing happened.
A patient I treated last month had spent three weeks reading horror stories online before her procedure. She came in expecting agony. The next morning she sent me a WhatsApp message: “Doctor, mujhe yakeen nahi aa raha. Bas thodi si jalan thi. Aaj office ja sakti hoon.” That is the typical reaction I see. I sometimes think the expectation gap is what makes laser sphincterotomy feel painless.
What Actually Happens During Laser Sphincterotomy
The procedure itself takes me 20 to 30 minutes. You arrive at the clinic, get changed, and meet the anaesthetist. I use spinal anaesthesia for most cases — you are awake, but you feel nothing from the waist down. Some patients prefer to be lightly sedated and I am happy to accommodate that.
Once anaesthesia is working, I position the laser fibre at the internal anal sphincter — the small muscle that has gone into painful spasm and is preventing your fissure from healing. I release the spasm with a controlled energy pulse without cutting through the muscle the way conventional lateral sphincterotomy does. The whole laser application takes me a few minutes.
You are wheeled to recovery, you wait for the spinal anaesthesia to wear off (about two hours), and you go home the same day. No overnight stay. No general anaesthesia hangover.
Pain During the Procedure — What You Will Feel
Nothing. I understand this is the part people do not believe until they experience it. Under spinal anaesthesia, the lower half of your body is genuinely numb. You can chat with the team if you want. Some patients fall asleep. I have had patients ask me “did you start?” — and I tell them it is already done.
Post-Operative Pain, Day by Day — What I See in My Patients
This is the part that actually matters. Here is what I see most patients experience after laser sphincterotomy:
Day 1 (procedure day): You are at home by evening. The anaesthesia is wearing off. You feel mild burning or pressure, similar to the fissure pain you had before but milder. I prescribe a simple painkiller (usually paracetamol-based) and a stool softener. Most patients sleep through the night.
Days 2 and 3: The first bowel movement is the moment I see patients dread most. With laser sphincterotomy and a proper stool softener, the first motion is uncomfortable but not the scream-inducing event that open surgery patients describe. I rate this pain as 3 to 4 out of 10 on day 2, dropping to 2 out of 10 by day 3 based on what my patients report back.
Days 4 and 5: Most patients are back to office work, light walking, normal eating. Sitting for long periods may still cause mild discomfort. The fissure burning that drove you to surgery is gone or nearly gone.
Week 2 onward: Pain is minimal. Healing is mostly complete. I confirm at follow-up review that the fissure has closed.
How This Compares to Old-School Open Surgery — My Honest Opinion
I totally do not agree with the idea that conventional lateral internal sphincterotomy (LIS) is “basically the same thing.” It is not. LIS involves an actual cut through the sphincter muscle. Recovery takes 4 to 6 weeks. The first week is brutal — I see this in patients who come to me for second opinions after LIS elsewhere. Many older patients still remember it vividly years later.
Laser sphincterotomy releases the same muscle spasm through controlled energy rather than a scalpel cut. No external wound. No sutures. I do not think the difference in post-operative pain is subtle — it is the reason patients fly in from Lahore, Hyderabad and the Gulf to have this procedure done in my clinic.
What I Recommend to Help With Pain at Home
Most patients need very little. The recovery kit I give every patient is simple:
- Sitz bath twice a day for the first week — warm water for ten minutes. I find this soothes the area and keeps it clean
- Stool softener for two weeks — I want your motions soft so the healing area is not stressed
- Mild oral painkiller for the first 48 hours, then only as needed
- High-fibre diet plus 2 to 3 litres of water daily
- Avoid spicy food for the first week — I know this is hard in a Karachi household, but it matters
I tell every patient: if pain ever exceeds what a painkiller can handle, call me immediately. In my experience that almost never happens, but I want you to know the door is open.
Who I Recommend Laser Sphincterotomy For
Chronic anal fissures that have not healed with three months of conservative treatment (sitz baths, stool softeners, topical creams, dietary changes) are the standard indication I follow. Acute fissures I usually manage without surgery. I find that patients with high resting anal pressure — the ones whose sphincter never relaxes — benefit most.
Cost and What Is Included
I charge Rs. 130,000 to Rs. 150,000 for laser sphincterotomy at Karachi Piles Clinic, depending on the case. This surgery price includes the procedure, anaesthesia, theatre charges and consumables. I confirm the final cost after assessment. Pre-operative consultation and any post-operative follow-up visits are charged separately at Rs. 2,000 per visit.
Frequently Asked Questions
Will I feel anything during the surgery?
No. Under spinal anaesthesia the area is completely numb. You may feel some pressure but no pain. I have never had a patient report procedure pain.
How soon can I go back to work?
I see most patients return to desk work within 3 to 5 days. Physically demanding jobs take a week to ten days.
Will the fissure come back?
Recurrence after laser sphincterotomy is uncommon in my experience, if dietary and bowel habits are corrected. Without those changes, I have seen fissures recur after any type of surgery.
Is this safe for women, including during reproductive years?
Yes. I deliberately use laser sphincterotomy because it preserves the sphincter muscle, which I believe is particularly important for women planning future childbirth.
Book a Consultation With Me
Ready to book a consultation? WhatsApp me directly: 0333-2877351. OPD timings: Tuesday, Thursday, Saturday — 5:00 PM to 8:00 PM. Karachi Piles Clinic, in Hill Park General Hospital, Shaheed-e-Millat Road. Consultation fee Rs. 2,000.
Related reading: laser sphincterotomy at Karachi Piles Clinic · anal fissure surgery cost breakdown · severe pain after motion explained.
