Over 200,000 Americans are diagnosed with anal fissures each year. These are not usually a serious condition, but they are most definitely uncomfortable. Although your fissures will usually heal on its own in four to six weeks, when it doesn't, we can help. Regardless of if your anal fissures isn't healing on its own or your anal fissures keeps coming back, our experts are here to help you get back to a more comfortable life.
An anal fissure is a tear is the lining of the anus, and can be very painful, especially during bowel movements. Treatment include changes to your diet and regular bowel habits. Your doctor may recommend surgery to quicken your healing. The purpose of this surgery is to loosen the muscular ring, or the anal sphincter.
Surgery for anal fissures
Most acute (short-term) fissures will heal on their own in 4-6 weeks. Surgery for anal fissures is generally reserved for people:
- With an anal fissure that has been present for more than 6 weeks (considered chronic)
- Who have tried medical therapy for at least one to three months and failed
Lateral sphincterotomy is the main surgery to treat anal fissures. During surgery your doctor makes a small cut in the internal muscle around the anus. This cut relaxes the muscle, preventing muscle spasms. It is these spasms which prevent the fissure from healing. The fissure itself is not closed with suture; it needs to heal on its own.
Risks of surgery
The most common risk with this surgery is the development of anal incontinence.
Anal incontinence can include inability to control gas or loss of solid stool. You can expect to have some mild, and temporary, leakage during your recovery period. About half of our patients experience this during the surgical healing process. This post-surgical incontinence is rarely permanent and is usually mild. It should end within a few weeks.
The risk of incontinence after sphincterotomy is higher for women who have had vaginal childbirth. It is also higher for patients that have had previous anal or rectal surgery.
You should discuss all your risks with your surgeon during your pre-surgical appointment.
We perform this surgery as an outpatient surgery, under general anesthesia. The pain from the sphincterotomy is usually mild and is often less than the pain of the fissure itself. You may have a small amount of blood or drainage from the anal area for several days after surgery. This should resolve on its own.
You may resume your usual diet immediately after surgery.
You will need to speak to your doctor, but, often, you can return to normal activity within one to two weeks .
It is very important to not allow yourself to become constipated after surgery.
To avoid constipation, we recommend:
- Starting a diet of high fiber the morning after surgery. Bran cereal, wheat or rye bread, fresh fruits, and vegetables are ideal.
- Mixing one tablespoon of Metamucil with eight ounces of water twice a day. You should start this on the morning after surgery.
- Taking Dulcolax stool softener (100mg) twice daily. This starts on the day before your surgery, and until you are no longer taking pain medication.
- If you go 48 hours without a bowel movement (BM), take two tablespoons of Milk of Magnesia. Continue taking every 6 hours until your first BM, and then stop.
- Call the office if you go more than 2 days without a BM or if you are having abdominal pain or abdominal distension.
- Drink plenty of water and juice and eat fresh fruits and vegetables.