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  • Anal Sphincterotomy

    (Sphincterectomy, Anal; Surgery for Anal Fissures; Lateral Internal Sphincterotomy; LIS)

    Definition

    This is a procedure to treat anal fissures. An anal fissure is a painful tear in the lining of the anus. The anus is the opening through which stool passes from the body. Tears generally occur just inside the opening.
    Anal Fissure
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    Reasons for Procedure

    Muscle spasms in the rectum can prevent fissures from healing. A sphincterotomy relieves these muscle spasms. Anal fissures often heal by taking certain steps, such as:
    • Eating a High-fiber diets
    • Drinking plenty of fluids
    • Using stool softeners
    • Taking warm baths
    • Using topical medicines (applied to the skin)
    When these do not work, a sphincterotomy may be done. This procedure allows the fissure to heal and decreases pain and spasms. It is usually very effective. Pain will begin to go away within a few days.

    Possible Complications

    Complications are rare. But, no procedure is completely free of risk. If you are planning to have a sphincterotomy, your doctor will review a list of possible complications, including:
    • Leakage of gas or stool from the rectum
    • Adverse reaction to anesthesia (eg, light-headedness, low blood pressure, wheezing)
    • Infection
    • Bleeding
    • Abscess or fistula formation
    Factors that may increase the risk of complications include:
    Discuss these risks with your doctor before the procedure.

    What to Expect

    Prior to Procedure

    Before surgery, your doctor may do the following determine the extent of your fissure:
    • Physical exam and health history
    • Digital rectal exam—The doctor inserts a lubricated finger into the anus and feels for lumps or abnormalities.
    • Anoscopy—A tool is inserted in the anus to allow the doctor to examine the anal canal.
    In the days leading up to the surgery, your doctor may:
    • Ask you to take steps to clean out your bowels. The day before the surgery:
      • Eat a light breakfast and lunch.
      • Drink clear liquids only after lunch. Clear liquids include items such as water, broth, juices without pulp, popsicles, and clear Jell-O. Talk to your doctor about which liquids are allowed.
      The night before surgery:
      • Do not eat or drink after midnight the night.
    • You may also be asked to give yourself an enema to help clean out your bowel. This is a fluid that is introduced into the rectum to stimulate bowel movements.
    You should also talk to your doctor about your medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen , naproxen )
    • Blood-thinning drugs, such as warfarin (Coumadin)
    • Anti-platelet drugs, such as clopidogrel (Plavix)

    Anesthesia

    Depending on which option is best for you, your doctor may give you:
    • Local anesthesia—This will only numb the rectal area.
    • General anesthesia —You will be asleep during the surgery.

    Description of Procedure

    If there are any skin tags near the fissure, they will be removed. Next, the doctor will carefully make a cut on the anal sphincter muscle. This will relax the sphincter and allow it to stretch, taking pressure off the fissure. The doctor will put a dressing into your anus to stop the bleeding.

    How Long Will It Take?

    Less than one hour

    How Much Will It Hurt?

    During the procedure, pain will be managed with a general or local anesthetic. The pain from your fissures will begin to go away in a few days. Your doctor may prescribe pain medicine to help you feel more comfortable.

    Post-procedure Care

    At the Care Center
    You may be given pain medicines and instructions for how to care for your rectal area. A nurse may change your dressing or instruct you on how to change it.
    At Home
    When you return home, follow your doctor's instructions for a smooth recovery, such as:
      Keep your rectal area clean:
      • Remove your dressing before having a bowel movement.
      • Take a sitz bath 3-4 times a day and after each bowel movement. Sitz baths will help relieve discomfort and clean the area. For a sitz bath, sit in warm water for 10-15 minutes. Pat the area dry. Do not wipe or rub. Devices are available to place on top of the toilet to make this process easier.
      • For a few days, use alcohol-free baby wipes rather than toilet paper to wipe after bowel movements.
      • You will have reddish-yellow drainage from your rectum for a week or more. Use sanitary pads to absorb the drainage. You may have increased bloody discharge after activity or bowel movements.
    • If you are taking pain medicine, you may need to take a stool softener to prevent constipation . Eating a high-fiber diet can also prevent you from becoming constipated.
    • Avoid sitting or standing for more than one hour at a time.
    • For the first six weeks, do not lift anything heavier than 10 pounds (4.5 kilograms).
    • Resume sexual activity when you feel comfortable.
    • Check with your doctor to see when you can return to work

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Large amounts of bleeding from the rectum
    • Fever
    • Foul-smelling drainage from the rectum
    • Excessive swelling in the rectal area
    • Unable to control bowel movements
    • Difficulty urinating
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Society of Colon & Rectal Surgeons http://www.fascrs.org/

    Family Doctor.org http://familydoctor.org/

    CANADIAN RESOURCES

    Canadian Society of Colon and Rectal Surgeons http://www.cscrs.ca/

    The College of Family Physicians of Canada http://www.cfpc.ca/Home/

    References

    Anal fissure. American Society of Colon & Rectal Surgeons website. Available at: http://www.fascrs.org/patients/conditions/anal%5Ffissure/ . Updated 2008. Accessed January 24, 2011.

    Anal fissure. Mayo Clinic website. Available at: http://www.mayoclinic.org/anal-fissure/ . Accessed January 24, 2011.

    Anal fissure/fistulotomy/sphincterotomy surgery. University of Wisconsin School of Medicine and Public Health, UW Health website. Available at: http://www.uwhealth.org/healthfacts/B%5FEXTRANET%5FHEALTH%5FINFORMATION-FlexMember-Show%5FPublic%5FHFFY%5F1105646271830.html . Updated October 2010. Accessed January 24, 2011.

    Anal fissures. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/anal%5Ffissures/hic%5Fanal%5Ffissures.aspx . Accessed January 24, 2010.

    Anal fissures. University of California San Francisco Medical Center website. Available at: http://www.ucsfhealth.org/education/anal%5Ffissures/ . Updated October 2010. Accessed January 24, 2011.

    Sphincterotomy. Baylor College of Medicine website. Available at: http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc%5Fname=sphincterotomy&content%5Fid=274 . Updated January 2011. Accessed January 24, 2011.

    Wood D. Anal Fissure. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated September 2010. Accessed January 24, 2011.

    6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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