- Internal anal sphincterotomy has proved to be the most effective in treating long-term anal fissures compared to any other medication.
- Your surgeon will most likely prescribe laxatives after surgery to help you prevent constipation.
- You may experience difficulties in controlling your bowel after undergoing anal fissure surgery which may lead to incontinence.
Anal Fissure Surgery
If other medications fail to get rid of anal fissure, a surgical procedure known as internal anal sphincterotomy may be necessary. It involves a small incision in one of the two anal muscles and is considered to be a minor surgery. Hence it can be offered as an outpatient surgery. It is done under general or local anesthesia.
It is normal for the internal anal sphincterotomy to be under tension when in a state known as resting pressure. If that pressure surpasses the normal limit, it can cause a tear or worsen the existing anal fissure. The purpose of the incision is to reduce the resting pressure allowing the tear to heal. It is however vital to note that the anal fissure should be left to heal on its own even with surgery. The purpose of the surgical procedure is to reduce the resting pressure and it involves operating on the sphincter muscle and not the anal fissure itself.
Internal anal sphincterotomy has proved to be the most effective in treating long-term anal fissures compared to any other medication. The condition rarely reoccurs and the results last longer in most cases where the surgical operation is involved.
You may notice that the pain reduces a great deal after the surgery. You can always take painkillers such as ibuprofen or paracetamol from local drug stores to ease the pain further. However, remember to consult your doctor first before you purchase them. Always check the information that comes with the drugs before purchasing. This way, you will avoid painkillers that contain codeine which can cause constipation.
Your surgeon will prescribe laxatives most likely after the surgery to help you prevent constipation. It is also advisable to use foods that are high in fiber. You should also increase your water intake to reduce the chances of the recurrence of anal fissure. Good examples of high-fiber foods that should be included in your diet are wholegrain cereals, fruits and vegetables. The wound should be left to heal on its own after the surgery. You should wash the area gently with water and soap after every visit to the toilet in order to keep it clean. It is important to follow your surgeon’s instructions since every case of anal fissure is different and needs special attention.
There are a number of side effects associated with anal fissure surgery. However, most of them are temporary. It is important to consult your surgeon in case of any side effects. You should not experience much pain after anal fissure surgery. It is only expected to be sore for around two weeks before it gets back to normal.
The Complications Involved
Complications can be described as unexpected problems that one may experience during or after the surgery. Some of them are:
i. Incontinence- It is important to keep in mind that you can experience incontinence before you decide to go through the surgery. It is a risk enough to make surgery seem like a bad idea in some cases. An example of these cases is when a woman experiences an anal fissure during child delivery yet the resting pressure in the internal sphincter is not high. Another procedure known as anal advancement flap may replace sphincterotomy. This procedure involves getting rid of the edges of the fissure and sewing the healthy parts over the area.
ii. Infections- You may develop an infection on your wound or nearby area which can make sitting down or opening up your bowels painful. This normally affects about two percent of patients who undergo anal fissure surgery. You can get rid of the infection by taking antibiotics or by draining the abscess.
iii. Fistula- About one percent of people develop fistula after the surgery. It is a small channel between the anal canal and the skin that normally develops when an abscess does not heal properly. However, anal fistula is usually not big and can be treated through a surgery.
You may experience difficulties in controlling your bowel after undergoing anal fissure surgery which may lead to incontinence. It mostly happens after sphincterotomy in about five percent of the cases. It may develop as a result of certain complications such as overstretching or damaging of the sphincter muscles during the surgery. You may notice liquid stools or mucus soiling your underwear or even lose control over wind.
There are rare cases of anal fissure returning after the surgery. When this happens, other alternative treatments may be recommended or you may have to undergo surgery further. However, the doctor will have to conduct some tests at first to determine the cause among other factors before deciding on the best way to move forward. Good examples of these causes are Crohn’s disease and other undiagnosed medical conditions.
Anal fissure surgery is usually recommended only after the other forms of treatment methods have been tried and failed to work, or if they have been found to be unsuitable for you. When other medications such as diltiazem cream fails to work, the next best option in most cases is the botulinum toxin injection. The injections normally last for up to three months and they work by relaxing the internal sphincter muscles to speed up the healing process.
You may witness a few temporary side effects such as muscle weakness. However in about fifty percent of the cases, anal fissure normally comes back within a year after the injections.
What to Expect During Anal Fissure Surgery
There are multiple surgical procedures that may be used to get rid of anal fissure. Your surgeon will decide the best one for you after a number of tests. If the first procedure fails to work, the surgeon may recommend another type of surgical procedure. These procedures include:
i. Lateral internal sphincterotomy
This procedure is usually the first option in most cases due to its effectiveness. It involves making a small cut in the internal anal sphincter muscle to ease the tension. It usually works in about 95% of the cases. It is however not recommended for people with long-term (chronic) diarrhea or women who are of childbearing age.
This procedure may be recommended if your surgeon thinks that sphincterotomy may lead to incontinence. It may also be recommended if you have irritable bowel syndrome or diabetes among other medical conditions. This procedure involves the removal of all the damaged skin surrounding your anal fissure leaving it to heal on its own.
iii. Advancement flaps
In this procedure, your surgeon will replace the damaged skin in your fissure with a piece of healthy skin from the anal lining. This can be done along with sphincterotomy or if the anal fissure does not heal after the first procedure.
How Long Does the Recovery Process Take?
The healing process after surgery can take up to six to ten weeks. However, the pain normally goes away within a few days of surgery.
The anal fissure can easily tear again after surgery if you have constipation. For this reason, it is important to include a lot of liquids in your diet to help keep your stool soft. You should also be sure to include high-fiber foods in your diet to reduce the risk of its recurrence.