What is the problem?
You have a split in the sensitive skin just inside the anus. The medical name for the split is an anal fissure. The fissure causes pain on passing a motion, and often some fresh bleeding. It is made worse by tightening or spasm of the anal sphincter that opens and closes the anus.
The aims of surgery:
The aim is to weaken the sphincter muscle by cutting one side of it. This is called a lateral sphincterotomy. This lets the fissure heal up within a week or so. The sphincter muscle will also recover in a week or two.
You should be able to have your operation as a day case, which means you come into hospital and go home the same day.
The pain and bleeding should stop. We will also examine the bowel with a type of telescope, called a sigmoidoscope, to make sure the tissues above the anus are healthy. This procedure is called a sigmoidoscopy and is often done at the same time as the operation.
Are there any alternatives?
The first line of treatment is usually a course of bathing and special creams containing muscle relaxants or local anaesthetic. If they do not work, the sphincterotomy is usually the next step.
Stretching the muscle is an alternative to cutting it, but there is a greater chance of poor control of your wind and motions after stretching, especially in older patients. There is also a higher chance of the fissure coming back.
If the anal sphincter is already weak, there is a higher than normal chance of poor control of the wind and motions after the operation. The sphincter may already be weakened in:
- The elderly
- Those who have already had operations on the anus, such as hemorrhoidectomy
- Women who have had stitches to repair tears during childbirth episiotomies.Very mild stretching or continuing with creams may be better alternatives in these cases.Cutting out the fissure is not usually needed but if we are concerned that another condition is present, we would cut the tissue out and send it for examination under the microscope.
A new technique is the injection of Botox into the area of the internal anal sphincter. The Botox causes paralysis of the internal anal sphincter within a few hours and weakening of the muscle for three to four months. This reduction in the resting pressure of the anal muscle is similar to a surgical lateral internal sphincterotomy and allows the fissure to heal.
What if you do nothing?
If you do nothing, the fissure may heal by itself. It is likely to come back, on and off, over time. The fissure may become thickened with scarring and not heal quickly after an operation in the future.
There is a small chance, perhaps one in 50, that there is a polyp or tumor in the bowel above the fissure. This would be missed if you did nothing.