Anal sphincterotomy 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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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.
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
- 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 scope 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 gelatin. Talk to your doctor about which liquids are allowed.
- Do not eat or drink after midnight the night before surgery:
- Use an enema if advised to do so by your doctor.
- The day before the surgery:
You should also talk to your doctor about your medications, herbs, and dietary supplements. You may be asked to stop taking some medications up to one week before the procedure.
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 on a dressing 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.
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 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
When you return home, you will need to take steps to promote healing and prevent infection. These will include:
- Keeping the rectal area clean
- Using a sitz bath to ease discomfort and cleaning
- Avoiding sexual activity and heavy lifting until your doctor says it is okay
Your doctor may advise:
- Over-the-counter or prescription pain relievers
- Stool softeners and dietary changes (including drinking more water) to prevent constipation
Call Your Doctor
Call your doctor if any of these occur:
- Large amounts of bleeding from the rectum
- 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 emergency medical services right away.
American Society of Colon and Rectal Surgeons https://www.fascrs.org
Family Doctor—American Academy of Family Physicians https://familydoctor.org
Canadian Society of Colon and Rectal Surgeons http://cscrs.ca
The College of Family Physicians of Canada http://www.cfpc.ca
Anal fissure expanded information. American Society of Colon and Rectal Surgeons website. Available at: https://www.fascrs.org/patients/disease-condition/anal-fissure-expanded-information. Accessed April 3, 2018.
Anal fissure. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T113851/Anal-fissure . Updated May 31, 2017. Accessed April 3, 2018.
Anal fissure treatments. University of Wisconsin School of Medicine and Public Health, UW Health website. Available at: https://www.uwhealth.org/healthfacts/surgery/5467.html. Updated November 16, 2016. Accessed April 3, 2018.
Anal fissures. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/diseases/13177-anal-fissures. Updated April 24, 2014. Accessed April 3, 2018.
Anal fissures. UCSF Medical Center website. Available at: https://www.ucsfhealth.org/education/anal%5Ffissures. Accessed April 3, 2018.
6/2/2011 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T905141/Treatment-for-tobacco-use : 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.
- Reviewer: EBSCO Medical Review Board Daus Mahnke, MD
- Review Date: 03/2018
- Update Date: 05/08/2014