An 'anal sphincterotomy' is the standard surgical procedure to correct an anal fissure. During the surgery the patient is under a general anaesthetic. Most anal sphincterotomies are performed as day surgery.
How should I prepare for surgery?
The day before admission we will contact you to confirm admission time and to give you instructions regarding any fasting requirements for the procedure. You should bring any x-rays in with you (and ensure you take them with you when you are discharged). Also bring any current medication in with you to the hospital.
For day procedures you should not drive yourself home when you are discharged - please ensure you have made other transport arrangements.
If you smoke, you should reduce smoking before your procedure. Our strong recommendation is that you give up entirely at least 6 weeks before the procedure, or at least one week beforehand. Smoking greatly increases the possibility of chest infection and hampers natural wound healing.
In the case of major surgery, please inform Dr White's team if you take:
- Anti-inflammatory medication.
We will need to discuss these medications with you prior to your surgery.
Dr White will provide you with a full set of pre-operative instructions for your specific surgery well ahead of the day of surgery.
What is involved in the procedure?
Anal fissures are caused and/or made worse by the presence of a spasm in the internal anal sphincter muscle. An anal sphincterotomy involves making a small incision through the lower section of the anal sphincter muscle tissue, which stops the spasm from occurring.
At the same time, if a skin tag is present (this is common) it is removed and the incision is then closed. The fissure itself is left to close naturally.
This procedure rarely requires a hospital stay – most patients can return home on the same day.
There is often moderate to severe pain after this procedure. There may be some pain once the effects of the local anaesthetic have worn off around two hours after the procedure.
If this is the case we recommend the following combination of Panadol and Ibuprofen for the initial 48-hour period after surgery:
- Two (500mg) Paracetamol tablets every four to six (4-6) hours.
- Two (200mg) Ibuprofen tablets every six to eight (6-8) hours.
If pain continues beyond this period, or if it becomes severe, you should contact your doctor.
In rare cases, this pain relief may not be sufficient – in which case you will need to take stronger pain relief. You will require a prescription for Panadeine Forte – two (500mg) tablets every six to eight (6-8) hours.
Regular salt baths, two to three times a day can provide some pain relief and help keep the wound clean. Simply run a shallow bath and add 2-3 tablespoons of table salt. It's also a good idea to have a salt bath after any bowel movements.
After the procedure you wound/s will be dressed. Stitches are generally not used in this procedure as they can lead to infection. Dressing/s can be removed on the evening of the day of the procedure, but not before. The easiest way to do this is to take a shower or bath and they will come off with a little assistance. Wound/s do not need to be dressed again - wearing an absorbent pad in your underwear should be enough to absorb any fluid coming from the wound. To stop any irritation of the nearby skin you should use a barrier cream (e.g. Bepanthen, Vasoline).
You may experience some pain, and you may see some blood in the toilet bowl or on toilet paper, when having a bowel movement. This may last for up to seven days after surgery. Apart from this there should be no further symptoms. It's important during this early stage to avoid becoming constipated, as this will make the pain worse. You may want to take a fibre supplement at this time to make sure your stools are loose (Normafibe is one we recommend - you need to take one teaspoon twice each day).
You should take a break from work and rest for four days after surgery. At this point you can return to work (light duties only) and resume general domestic activity. Anything more strenuous, such as sport or demanding manual labour, should be avoided until 2-3 weeks after the procedure. It is also advisable to build up to strenuous activity gradually, and listen to your body – if you feel any pain you should ease off.
All types of surgery are subject to the following risks, which are rare, but can occur:
- Allergic reaction to medication / anaesthetic.
- Difficulty breathing.
Complications after surgery to correct an anal fissure can also on rare occasions include:
- Small abscess development (~2% risk).
- Fistula development (<1% risk).
- Fissure not healing / recurring* (1-6% risk).
* studies indicate that around half of all patients with non-healing / recurring anal fissures have undiagnosed Crohn's Disease.
When to contact Dr White
Most surgical procedures are uneventful, with minimal complications. However, you need to be aware of the following symptoms as they may indicate a developing serious complication...
- Excess bleeding.
- Difficulty urinating.
- Severe or increasing pain.
If you experience any of these symptoms or have any concerns after your surgery, please contact the rooms on 07 5598 0955 for advice.
A post operative appointment will be made for you before you are discharged from hospital. If you are discharged on a weekend, after normal surgery hours or it is not clear what follow up appointments are required, then contact the rooms the next working day to make an appointment.