Anal Fissure Surgery: What to Expect and How to Prepare

Tuesday, 28th May 2024

Anal fissures are small tears in the lining of the anus that can cause significant pain and discomfort. When conservative treatments fail to heal the fissure, surgery may be necessary. This guide provides an overview of what to expect from anal fissure surgery and how to prepare for it.

What is an Anal Fissure?

An anal fissure is a small tear in the thin, moist tissue (mucosa) lining the anus. Fissures can cause pain and bleeding during bowel movements. They are typically caused by passing large or hard stools, chronic diarrhea or constipation, inflammation, or childbirth.

When is Surgery Needed?

Surgery is considered when:

1. The fissure does not heal with conservative treatments such as topical medications, stool softeners, and dietary changes.
2. The pain is severe and persistent.
3. There are recurrent fissures or complications such as an anal fistula.

Types of Anal Fissure Surgery

Lateral Internal Sphincterotomy (LIS)

Lateral internal sphincterotomy (LIS) is the most common and effective surgical treatment for chronic anal fissures. It involves making a small incision in the internal anal sphincter muscle to reduce spasm and pain, promoting healing.

Benefits:

1. High success rate with long-term relief.
2. Reduces pain and promotes faster healing.

Risks:

1. Risk of temporary or permanent incontinence (rare).
2. Infection or bleeding at the surgical site.

Other Surgical Options

In rare cases where LIS is not suitable, other surgical options may include:

1. Fissurectomy: Removal of the fissure and surrounding scar tissue.
2. Advancement Flap: Repair of the fissure using a flap of healthy tissue from nearby.

Preparing for Anal Fissure Surgery

Pre-Surgery Consultation

During your pre-surgery consultation, your doctor will:

1. Review your medical history and current medications.
2. Perform a physical examination and possibly recommend additional tests.
3. Discuss the type of surgery and what to expect.
4. Provide specific instructions on how to prepare for surgery.

Pre-Surgery Instructions

To prepare for anal fissure surgery, you may need to:

1. Stop Certain Medications: Follow your doctor’s advice on which medications to stop before surgery, such as blood thinners.
2. Arrange Transportation: Since you may be under anesthesia, arrange for someone to drive you home after the procedure.
3. Plan for Recovery: Prepare your home for a comfortable recovery by setting up a rest area and ensuring you have essential supplies on hand.

What to Expect on the Day of Surgery

Before the Surgery

1. Check-In: Arrive at the hospital or surgical center as instructed and check in for your procedure.
2. Pre-Operative Prep: You will be prepped for surgery, which may include changing into a surgical gown and having an IV line started.
3. Anesthesia: You will receive local, regional, or general anesthesia to ensure you are comfortable during the procedure.

During the Surgery

The specifics of the surgery will depend on the type of procedure being performed. Generally, the steps include:

1. Incision: The surgeon makes a small incision to access the fissure or the sphincter muscle.
2. Repair: The fissure is treated, and the muscle is cut to reduce tension and spasm.
3. Closure: The incision is closed with sutures or left to heal naturally.

After the Surgery

1. Recovery Room: You will be taken to a recovery room to wake up from anesthesia. Your vital signs will be monitored.
2. Discharge: Depending on the surgery and your recovery, you may be able to go home the same day or you may need to stay in the hospital overnight.

Recovery After Anal Fissure Surgery

Immediate Post-Surgery Care

1. Pain Management: You will be given pain medication to manage any discomfort.
2. Activity Restrictions: You will need to avoid strenuous activities and heavy lifting for a specified period.
3. Wound Care: Keep the surgical site clean and dry. Follow your doctor’s instructions for wound care and dressing changes.

At Home

1. Rest: Get plenty of rest and gradually increase your activity level as advised by your doctor.
2. Diet: Follow a high-fiber diet to prevent constipation and ensure smooth bowel movements. Drink plenty of fluids.
3. Stool Softeners: Use stool softeners or laxatives as prescribed to avoid straining during bowel movements.

Follow-Up

1. Appointments: Attend all scheduled follow-up appointments to monitor your recovery and address any concerns.
2. Symptoms: Contact your doctor if you experience severe pain, fever, increased bleeding, or signs of infection at the surgical site.

Long-Term Recovery

1. Hygiene: Maintain good anal hygiene to prevent infection and promote healing.
2. Exercise: Begin with light exercises, such as walking, and avoid heavy lifting until your doctor gives the go-ahead.
3. Lifestyle Changes: Incorporate dietary and lifestyle changes to prevent future fissures, such as eating a high-fiber diet, staying hydrated, and avoiding straining during bowel movements.

Success Stories: Real Patient Experiences

Emily’s Quick Recovery

Emily, a 30-year-old office worker, shares her experience: "I had been suffering from a painful anal fissure for months. After the lateral internal sphincterotomy, I felt immediate relief. The recovery was straightforward, and I was back to my normal activities within a few weeks. I'm so glad I opted for the surgery."

James’ Journey with Chronic Fissures

James, a 45-year-old teacher, recounts his journey: "Dealing with recurrent fissures was a nightmare. The fissurectomy surgery finally gave me relief. The recovery took some time, but the pain is gone, and I can focus on my job and life again without constant discomfort."

Conclusion

Anal fissure surgery is a common and generally effective procedure for treating chronic anal fissures. Understanding what to expect and how to prepare can help ensure a smooth and successful outcome. If you are considering anal fissure surgery, consult with your healthcare provider to discuss your treatment options and take the first step towards relief and recovery.