Anal Fissure

Anal FissureAnal fissures are painful cracks or disruptions on the surface of skin or lining around the anus. It can be caused by stretching of the anal canal, usually from hard, dry bowel movements or loose, frequent bowel movements. Anal Fissure Surgery (Partial Lateral Internal Sphincterotomy) is a common outpatient procedure performed to allow a chronic anal fissure to heal.

Indications: 

Surgery may be indicated for chronic anal fissures that last longer than 6 weeks without healing.

Pre-Op Evaluation and Prep: 

Patients will have a physical exam by the surgeon to discuss symptoms and determine if surgery is needed. Routine blood work is usually not needed but may be ordered prior to surgery based on the patient's age and the presence of any existing medical problems.

For more information related to preparation for surgery click here.

Procedure: 

The surgeon will make an incision in the internal anal sphincter. The internal anal sphincter is a ring of muscle that controls the anus. This helps relieve the pressure and allows the anal fissure to heal.

Recovery:

This varies from patient to patient. Many patients return to desk type work the next day. You will probably have lifting restrictions for at least 48 hours. It is rare for patients to need extended time off of work, although it may take 6-10 weeks for complete healing.

While recovery instructions may be tailored to individualize a plan of care based upon your specific needs, these instructions are common following anal fissure surgery:

  • You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home.
  • When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.
  • Avoid fried foods, milk products and citrus juices for around one day after your surgery. Suggestions for foods to eat include soup, sandwich, pasta, potatoes, toast, and applesauce.  
  • You will have a dressing taped over your incision. The dressing may come off before 24 hours, if so that is fine.  You may use a feminine hygiene pad in your underwear for any drainage you may have. 
  • You will probably be instructed to shower 24 hours after your procedure. 
  • Starting the morning after your procedure, you will be instructed to take a sitz bath at least three times a day and after a bowel movement.  This is just sitting in a tub of warm water for 10-15 minutes.  Warm (sitz) baths increase blood flow and help relax the muscles in the area of your procedure in addition to keeping the area clean.
  • You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities and a medication regimen. Often times we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.
  • You will be instructed to take Miralax starting the day after surgery and continue to take that while on narcotic pain medication.
  • In addition to the stool softener it is recommended to include fiber in your diet.  Eat two servings of a high fiber fruit or vegetable with each meal.  You can also take a fiber supplement such as FiberCon tablets.  Start with two tablets a day and you can take up to six tablets a day.
  • It is important to maintain good bowel habits to facilitate healing. Stay hydrated by drinking plenty of caffeine-free fluids. Do not ignore the urge to have a bowel movement as this can lead to constipation. It is important not to strain or sit on the toilet for extended periods of time because this increases pressure in the anal canal.

For additional information for after surgery preparation click here.

To Schedule an Appointment

To find out more about Anal Fissure surgery services offered at CSA Surgical Center in Columbia, Missouri please call Columbia Surgical Associates at 573-443-8773 and schedule an appointment.