Sphincterotomy - Anal Fissure Surgery

Anal Fissure Treatment Overview

In the most general terms, an anal fissure is a tear in the thin tissue lining the anus, known as the mucosa. Most fissures occur when trying to pass large or hard stools during a bowel movement. This tear can result in a sudden and intense burst of pain around the anal sphincter, often accompanied by occasional spasms in the anal muscles. Pain may last up to several hours after a bowel movement, and rectal bleeding is quite common.

Anal fissures can affect people of any age. In most cases, anal fissures often heal on their own with time and care, however, this experience is not universal. Most health care providers will advise adding more fiber to your diet to soften stool and taking sitz baths after bowel movements to help relax the anal sphincter muscle and relieve pain. 

While many anal fissures heal on their own, some can become a chronic issue. When an anal fissure persists for more than eight weeks, it’s called a chronic anal fissure. Sphincterotomy surgery may be necessary if the fissure does not heal on its own.

Why?

An untreated chronic anal fissure can cause excessive rectal bleeding, dizziness, and fatigue. It can also trigger a cycle of discomfort—usually driven by a fear of bowel movements, which causes constipation and further aggravates the fissure when hardened stool is passed.

Moreover, the tear may extend into the internal anal sphincter, the ring of muscle that holds your anus closed. This can lead to a loss of control over your sphincter. The ultimate goal of an anal fissure surgery is to improve the quality of life and relieve pain. If pain is disrupting your daily life and you have exhausted all other medical treatments, it may be time to consider surgical options.

Sphincterotomy has a success rate of up to 90% in treating chronic fissures, with recurrence being rare. All surgeries, whether they be big or small, carry risks. For anal fissure surgery, or a sphincterotomy, these typically include:

What to expect prior to your surgery

Your health care provider may recommend taking antibiotics before surgery to prevent infection. Routine blood work is usually not required but may be ordered depending on your age and any existing medical conditions.

A sphincterotomy is generally a minor surgery performed on an outpatient basis, meaning you will be able to go home after the procedure. Before the surgery, a nurse or doctor will clean the affected area and consult with you to address any questions you may have. They will then numb the area using a local anesthetic to help relax the anal sphincter muscles and ensure you won’t feel discomfort during the procedure. General anesthesia is reserved for more severe cases but may be administered under your surgeon's recommendation.

The procedure itself can last anywhere from a few minutes to an hour, depending on the severity of the fissure. Typically, your doctor will give you a heads up on how long the procedure should last.

Anal Fissure Treatment Options

Several types of sphincterotomy procedures can be performed, including lateral internal sphincterotomy, fissurectomy, and a V-Y advancement flap. The lateral internal sphincterotomy is the most common surgical treatment for chronic anal fissures. Be sure to consult your surgeon about which treatment is best suited for you.

A lateral internal sphincterotomy (LIS) may be performed as an open or closed surgery. In an open surgery, an anoscope—a clear, hollow tube between three and five inches long and about two inches wide—is inserted into the anal sphincter to allow the surgeon to see the muscle and fissure. An incision is then made with a scalpel within the confines of the anoscope. In contrast, a closed surgery involves making the incision without the use of an anoscope and is typically reserved for specialists trained in this technique.

After the procedure

Recovery time for a sphincterotomy varies, but the recovery timelines is similar to that of fecal incontinence surgery. Most acute anal fissures heal within 6 to 8 weeks with conservative treatment. Residual pain may persist for up to a week after surgery. It is essential to keep the area clean and dry to avoid infection. Itchiness or soreness is common after anal fissure treatment. Always communicate with your healthcare provider if you have any concerns, especially if you experience symptoms like swelling, excessive pain, or changes in bowel control during your recovery.

You will need to arrange for a ride home on the day of your anal fissure treatment in Montreal. We recommend that someone stay with you for the first 24 hours at home. After surgery, you should go home and rest, avoiding any other plans for the day. Starting the next day, you can gradually increase your activity as you feel capable.

A prescription for pain medication will likely be provided. The recovery nurse will discuss a pain control plan tailored to your needs, which may include applying ice over incisions and following a medication regimen. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication. Post-operative care often includes sitz baths to promote healing and reduce discomfort. Your surgeon may also prescribe stool softeners, such as docusate, to ease bowel movements and prevent strain on the surgical