What is an anal fissure?
A fissure is a split in the skin at the opening of the anus, which leaves exposed some of the muscle fibres of the anal canal. Pain results from the recurrent opening of the wound when the bowels are opened and it is often accompanied by bleeding. In addition, the inner circle of muscle in the anal canal (called the internal sphincter) goes into spasm: this makes the pain worse and can prevent healing.
Why is surgery necessary for anal fissures?
Surgery is required for some types of fissures that do not respond to simpler forms of treatment.
What does the operation entail?
The operation to treat anal fissures is called an internal sphincterotomy. It involves that a part of the internal sphincter muscle being cut. The cut relieves the tension of the muscle and allows the fissure to heal. Occasionally, a polyp can develop at the edge of a long-standing fissure, and this might be removed at the same time. It is not usually necessary to remove or suture the fissure itself.
What can go wrong?
Internal sphincterotomy is generally a very safe operation with few risks, but (as with any surgical procedure) complications can occur.
Is there any special preparation required before the surgery?
In general, anal fissure surgery can be performed on a day-case basis, although occasionally other medical factors or social circumstances might make it necessary for you to stay in hospital. Before your admission, you should be on a high-fibre diet and a fluid intake of at least 6–10 glasses of water daily to keep your bowel motion soft. Owing to the painful nature of a fissure, you will not be given an enema or suppositories before the operation.
What kind of anaesthetic will I have?
Several different kinds of anaesthesia can be used, and the method will be tailored to your particular needs and wishes. With general anaesthesia, you will be asleep for the entire procedure. Some patients are better suited to a spinal or caudal anaesthetic. This is a small injection in the lower back to numb the area so that you will not feel the surgery. With a spinal or caudal anaesthetic, you will be conscious and able to talk to the anaesthetist during the procedure. Some patients who undergo day-case surgery or 23-hour-stay surgery will not require a general anaesthetic. Instead, controlled sedation and injection of a local anaesthetic allow the operation to be performed painlessly and a rapid recovery. Most patients who have had sedation, do not remember the surgery taking place.
Pain relief for the surgery
Internal sphincterotomy is a very simple operation and many patients experience less pain after their operation than before. However, in order to minimise the discomfort, a number of measures are available:
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at the time of surgery, a local anaesthetic will be injected. This will provide pain relief for much of the day
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after surgery, you will be given painkillers to take by mouth
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you may have sitz baths (a 15-minute bath in water as warm as you can tolerate) several times daily, or as often as you require them. These are very soothing and can provide several hours of pain relief.
How fast will I recover after the operation?
Within one to two hours of your operation, you will be encouraged to get up and walk around. You may eat and drink normally, and (as before) we recommend a high-fibre diet and fluid intake of at least 6–10 glasses of water daily. For planned day-case surgery, discharge from hospital will be the same day, or the following day. You should expect to defecate within one to three days, and this might be uncomfortable at first; a small amount of bleeding is possible. During the first few weeks, you might notice some change in your ability to control wind from the back passage; in most cases, this problem will resolve completely, but in a small proportion of people, it can be permanent. Provided you feel comfortable, there are no restrictions on activity and you may lift things, drive and go back to work.
What should I look out for after the operation?
After your operation, you should contact your general practitioner, specialist nursing staff or the ward if you notice any of the following problems:
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increasing pain, redness, swelling or discharge
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severe bleeding
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constipation for more than three days, despite using a laxative
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difficulty in passing urine
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high temperature over (38ºC) or chills
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nausea or vomiting.
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