(sphincterotomy, anal dilation)

Anal Fissure Surgery

Following factors result in anal fissures:

• Passing hard stools resulting in the damage of the lining in the anal canal.
• Muscle tone increase in the anal canal
• Reduction in nitric oxide synthesis which is responsible for facilitating relaxation of the internal anal muscles.

A sphincterotomy is a surgical procedure used to treat anal fissures.

When other methods of treatment fail then the doctors recommend sphincterotomy or fissure surgery.

The surgical methods to treat anal fissures are as follows:

• Lateral internal sphincterotomy
• Fissurectomy
• V-Y advancement flap

Sphincterotomy is performed under the following circumstances:

• When there is chronic anal fissures and the pain is uncontrollable
• Complicated fissures due to underlying  infected fistula
• Bleeding in the anal region
• Prior medical complications resulting in fissures

Following are the symptoms of fissures:

• Blood in the stools
• A small lump near the skin in the anal area
• Pain while passing stools
• Pain for several hours after passing stools that keeps increasing and recurring

Surgery is required in very few cases, unless the fissures are not chronic in nature and mild pain and swelling can be relieved with some home remedies like eating high fiber food which make the bowel movement easier by softening the stools and increasing the bulk of the stools passed.

Pain killers can also provide relief.

Application of creams with hydrocortisone helps and using pads with witch hazel or any other numbing agent helps.

Soaking the anal area in warm water for 10 to 15mins every day for 2 to 3 three times will provide relief.

Doctors might suggest creams, ointments and pads containing ingredients such as witch hazel, or hydrocortisone and lidocaine. Along with the above mentioned remedies.

Drinking a lot of water will prevent hard stools and in turn facilitate easier bowel movement.

Medications such as diltiazam, nifedipine, or nitroglycerin ointment help in relaxing the anal sphincter muscles aiding recovery.

Stool softeners are also recommended in order to make passing stools easy.

Externally applied nitroglycerin promotes blood flow and this helps the anal sphincter to relax thus facilitating the fissures to heal.

Botulinum toxin type A (Botox) injection relaxes the anal sphincter when administered and helps in relaxing spasms.

If the fissures are too chronic and do not respond to any non-surgical treatments then sphincterotomy is performed. The procedure is conducted under the influence of local or general anesthesia. The surgery involves cutting of small portion of anal sphincter muscle which will facilitate healing and recovery from the fissure.

The doctor will advise bed rest for 24 hours after the surgery.

During the recovery process any kind of strenuous activity like heavy lifting and jarring movements should be avoided.

There might be some cramping post the surgery which will go away in a day or two.

Nausea felt by the patient immediately after the surgery is due to the anesthesia.

The patient might also feel constipated after surgery in such a case he/she can ask doctors for remedial medicines.

In case of bleeding, urination related issues, fever and pus formation in the incisional region it is better to get in touch with the doctor.