This is a procedure to treat chronic anal fissures. An anal fissure is a painful tear in the lining of the anus. The anus is the opening through which stool passes from the body. Tears generally occur just inside the opening.
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Muscle spasms in the rectum can prevent fissures from healing. A sphincterotomy relieves these muscle spasms. Anal fissures often heal by taking certain steps, such as:
high-fiber dietDrinking plenty of fluidsUsing stool softenersTaking warm bathsUsing medications applied to the skin
When these do not work, a sphincterotomy may be done. This procedure allows the fissure to heal and decreases pain and spasms. Pain will begin to go away within a few days.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like: Inability to control the leakage of gas or stool from the rectumAdverse reaction to anesthesiaInfectionBleeding
Anal abscess or fistula formation
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as: SmokingDrinkingChronic diseases, such as diabetes or obesity
Before surgery, your doctor may do the following determine the extent of your fissure: Physical exam and health historyDigital rectal exam—The doctor inserts a lubricated finger into the anus and feels for lumps or abnormalities.Anoscopy—A tool is inserted in the anus to allow the doctor to examine the anal canal.
In the days leading up to the surgery, your doctor may:
Ask you to take steps to clean out your bowels.
The day before the surgery:
Eat a light breakfast and lunch.Drink clear liquids only after lunch. Clear liquids include items such as water, broth, juices without pulp, popsicles, and clear Jell-O. Talk to your doctor about which liquids are allowed.Do not eat or drink after midnight the night before surgery:You may also be asked to give yourself an enema to help clean out your bowel. This is a fluid that is introduced into the rectum to encourage bowel movements.
You should also talk to your doctor about your medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like: Anti-inflammatory drugsBlood thinnersAntiplatelets
Depending on which option is best for you, your doctor may give you: Local anesthesia that will only numb the rectal areaGeneral anesthesia
—You will be asleep during the surgery
If there are any skin tags near the fissure, they will be removed. Next, the doctor will carefully make a cut on the anal sphincter muscle. This will relax the sphincter and allow it to stretch, taking pressure off the fissure. The doctor will put a dressing into your anus to stop the bleeding.
Anesthesetics will prevent pain during the procedure. Pain and discomfort after the procedure can be managed with medications.
You may be given pain medications and instructions for how to care for your rectal area. A nurse may change your dressing or instruct you on how to change it.
During your stay, the care center staff will take steps to reduce your chance of infection, such as: Washing their handsWearing gloves or masksKeeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as: Washing your hands often and reminding your healthcare providers to do the sameReminding your healthcare providers to wear gloves or masksNot allowing others to touch your incision
When you return home, follow your doctor's instructions for a smooth recovery, such as:
Keep your rectal area clean:
Remove your dressing before having a bowel movement.Take a sitz bath 3-4 times a day and after each bowel movement. Sitz baths will help relieve discomfort and clean the area. For a sitz bath, sit in warm water for 10-15 minutes. Pat the area dry. Do not wipe or rub. Devices are available to place on top of the toilet to make this process easier.For a few days, use alcohol-free baby wipes rather than toilet paper to wipe after bowel movements.You will have reddish-yellow drainage from your rectum for a week or more. Use sanitary pads to absorb the drainage. You may have increased bloody discharge after activity or bowel movements.
If you are taking pain medication, you may need to take a stool softener to prevent
. Eating a high-fiber diet can also prevent you from becoming constipated.
Avoid sitting or standing for more than one hour at a time.For the first six weeks, do not lift anything heavier than 10 pounds (4.5 kilograms).Resume sexual activity when you feel comfortable.Check with your doctor to see when you can return to work
After arriving home, contact your doctor if any of the following occurs: Large amounts of bleeding from the rectumFeverFoul-smelling drainage from the rectumExcessive swelling in the rectal areaInability to control bowel movementsDifficulty urinating
If you think you have an emergency, call for medical help right away.
Anal fissure. American Society of Colon & Rectal Surgeons website. Available at:
http://www.fascrs.org/patients/conditions/anal_fissure. Updated October 2012. Accessed May 28, 2013.
Anal fissure. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated November 20, 2012. Accessed May 28, 2013.
Anal fissure/fistulotomy/sphincterotomy surgery. University of Wisconsin School of Medicine and Public Health, UW Health website. Available at:
http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-Show_Public_HFFY_1105646271830.html. Updated April 24, 2013. Accessed May 28, 2013.
Anal fissures. Cleveland Clinic website. Available at:
http://my.clevelandclinic.org/disorders/anal_fissures/hic_anal_fissures.aspx. Updated April 19, 2010. Accessed May 28, 2013.
Anal fissures. University of California San Francisco Medical Center website. Available at:
http://www.ucsfhealth.org/education/anal_fissures/. Accessed May 28, 2013.
6/6/2011 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis.
Am J Med.
Last reviewed March 2014 by Daus Mahnke, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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