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Anal Sphincterotomy

(Sphincterectomy, Anal; Surgery for Anal Fissures; Lateral Internal Sphincterotomy; LIS)

Definition

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.
Anal Fissure
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Reasons for Procedure

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:
  • Eating a high-fiber diet
  • Drinking plenty of fluids
  • Using stool softeners
  • Taking warm baths
  • Using 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.

Possible Complications

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 rectum
  • Adverse reaction to anesthesia
  • Infection
  • Bleeding
  • 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:

What to Expect

Prior to Procedure

Before surgery, your doctor may do the following determine the extent of your fissure:
  • Physical exam and health history
  • Digital 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 drugs
  • Blood thinners
  • Antiplatelets

Anesthesia

Depending on which option is best for you, your doctor may give you:
  • Local anesthesia that will only numb the rectal area
  • General anesthesia —You will be asleep during the surgery

Description of Procedure

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.

How Long Will It Take?

Less than one hour

How Much Will It Hurt?

Anesthesetics will prevent pain during the procedure. Pain and discomfort after the procedure can be managed with medications.

Post-procedure Care

At the Care Center
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.
Preventing Infection
During your stay, the care center staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping 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 same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
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 constipation . 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

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:
  • Large amounts of bleeding from the rectum
  • Fever
  • Foul-smelling drainage from the rectum
  • Excessive swelling in the rectal area
  • Inability to control bowel movements
  • Difficulty urinating
If you think you have an emergency, call for medical help right away.

RESOURCES

American Society of Colon & Rectal Surgeons http://www.fascrs.org

Family Doctor—American Academy of Family Physicians http://familydoctor.org

CANADIAN RESOURCES

Canadian Society of Colon and Rectal Surgeons http://www.cscrs.ca

The College of Family Physicians of Canada http://www.cfpc.ca

References

Anal fissure. American Society of Colon & Rectal Surgeons website. Available at: http://www.fascrs.org/patients/conditions/anal%5Ffissure. 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%5FEXTRANET%5FHEALTH%5FINFORMATION-FlexMember-Show%5FPublic%5FHFFY%5F1105646271830.html. Updated April 24, 2013. Accessed May 28, 2013.

Anal fissures. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/anal%5Ffissures/hic%5Fanal%5Ffissures.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%5Ffissures/. 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. 2011;124(2):144-154.e8.

Revision Information

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