Understanding Surgical Options for Treating Chronic Anal Fissures

Anal fissures are painful, often frustrating conditions that can significantly affect one’s daily life. These small tears in the skin around the anus are typically caused by trauma, such as passing large or complex stools. Though many anal fissures heal with conservative treatments like increased fiber intake, topical medications, and warm baths, some people experience persistent or recurring fissures that resist healing. When this occurs, surgical treatment may be necessary. This article will explore what individuals can expect from surgical intervention for anal fissures and the recovery process following such procedures.

When to Consider Surgery for Anal Fissures

Most anal fissures are acute and heal on their own with appropriate treatment. However, in some instances, fissures become chronic, lasting more than eight weeks despite conservative care. Chronic fissures are often associated with painful muscle spasms in the internal anal sphincter, which makes healing difficult. Additionally, repeated or prolonged anal fissures can lead to the formation of a skin tag or scar tissue that impedes the healing process.

If non-surgical treatments fail to alleviate symptoms and the fissure persists, surgery becomes a necessary option. Patients who experience constant pain, bleeding during bowel movements, or discomfort from swelling may find relief through surgical intervention. In some cases, chronic fissures are caused by an underlying condition, such as Crohn’s disease, requiring more comprehensive treatment. Before opting for surgery, doctors typically exhaust conservative methods to ensure that surgical treatment is the most appropriate option.

Types of Surgical Treatments for Anal Fissures

The most common surgical treatment for anal fissures is lateral internal sphincterotomy. This procedure involves making a small incision in the internal anal sphincter to release the muscle spasm that prevents the fissure from healing. Relaxing the sphincter muscle promotes blood flow to the area and facilitates healing. Lateral internal sphincterotomy is considered highly effective, with a success rate of around 90%, in providing relief from chronic fissures.

Another surgical approach involves Botox injections, which can be used to temporarily paralyze the internal anal sphincter, relieving spasms and allowing the fissure to heal. While Botox is less invasive than sphincterotomy, its effects are temporary, and repeat injections may be required. Some patients who prefer non-invasive treatments or are not candidates for surgery may opt for Botox as a viable option, though it may not always provide lasting relief.

Preparing for Anal Fissure Surgery

Before undergoing surgery for an anal fissure, patients will meet with their surgeon to discuss the procedure in detail. Preparation typically includes fasting for several hours before the operation, as surgery is often done under local anesthesia or sedation. Patients will be instructed to avoid certain medications that could increase the risk of bleeding, such as blood thinners, in the days leading up to the procedure. It is essential to follow these instructions carefully to ensure the procedure is as smooth and safe as possible.

On the day of the surgery, patients will be given local anesthesia, which numbs the surgical area. If sedation is used, the patient may remain relaxed or lightly asleep throughout the procedure. The surgery itself is relatively quick, typically taking no more than 30 minutes. Most anal fissure surgeries are performed on an outpatient basis, meaning patients can return home the same day, although they will need someone to drive them due to the effects of the anesthesia.

What to Expect During Recovery

Post-surgery recovery for anal fissures is usually manageable, though there are some things to keep in mind. Most patients experience some discomfort in the days following the procedure, particularly during bowel movements. This is expected and typically subsides within a few days as the body heals. To minimize discomfort, doctors may prescribe pain medications or recommend over-the-counter treatments to alleviate soreness. 

Maintaining good hygiene is crucial during recovery. To soothe the area and promote healing, patients should take regular sitz baths, which involve sitting in warm water. Additionally, a diet high in fiber and adequate fluid intake is essential to prevent constipation and avoid straining during bowel movements. Stool softeners may be recommended to make bowel movements more manageable and reduce the risk of re-injuring the surgical site. By following these post-operative guidelines, patients can ensure that their recovery goes smoothly.

Risks and Potential Complications

Like any surgery, there are risks associated with surgical treatment for anal fissures. The most common complication is infection, which can occur without proper hygiene. Patients are typically advised to avoid strenuous physical activities, such as heavy lifting, in the weeks following surgery to avoid straining the affected area. While infection is possible, it can be managed with antibiotics if detected early.

In some rare cases, patients may experience incontinence, a condition in which the ability to control bowel movements is impaired. This is a possible, though uncommon, side effect of sphincterotomy, as the surgery involves altering the anal sphincter muscle. However, this risk is low; most patients recover without long-term complications. Patients must follow their surgeon’s aftercare instructions to reduce the likelihood of such issues.

The majority of individuals who undergo surgery for anal fissures experience a significant improvement in their symptoms. The most commonly performed procedure, lateral internal sphincterotomy, has a high success rate, with most patients seeing complete resolution of their symptoms. In cases where Botox injections are used, many individuals experience relief, though repeat treatments may be necessary for sustained results.