Anal Fissure Treatment

Understanding Anal Fissures

Anal fissures are small tears or cuts in the lining of the anus, the opening where faeces are excreted. These fissures can cause discomfort, pain, and bleeding during bowel movements.

When Does Surgery Become Necessary

Anal fissures often heal on their own, without surgical treatments. However, when a fissure persists despite these treatments, or if it is large or deep, anal fissure surgery may be recommended. This surgery can help alleviate the pain and discomfort associated with chronic anal fissures.

Overview of the Surgical Procedure

Anal fissure surgery, also known as a lateral internal sphincterotomy, involves making a small incision in the internal anal sphincter - a ring of muscle that controls the anus. This helps reduce pressure in the anal canal, allowing the fissure to heal.

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Related Concerns

Chronic anal fissures can lead to complications such as anal spasms, a decrease in quality of life due to persistent pain, and in rare cases, an abscess or fistula.

Causes of the Issues

Anal fissures are often caused by passing large or hard stools. Other causes can include childbirth, anal sex, or diseases that affect the anal area like Crohn's disease or anal cancer.

Treatment Approaches

Treatment for anal fissures starts with simple measures such as dietary changes, medication, and sitz baths. If these measures fail, procedures like Botox injections or surgery may be recommended.

Service Overview

Anal fissure surgery is a highly effective treatment for chronic anal fissures. It offers a high success rate and low risk of complications, making it a suitable solution for those suffering from this condition.

Step-by-Step Guide to Anal Fissure Surgery

1. Pre-surgery preparations: Follow a high-fibre diet, use stool softeners, and avoid straining during bowel movements. Undergo preoperative tests, such as blood tests and an ECG.
2. Hospital arrival: Arrive at the hospital and complete the necessary paperwork, including signing a consent form.
3. Anaesthesia: The patient is placed under anaesthesia to ensure comfort during the procedure.
4. Incision: The surgeon makes a small incision in the internal anal sphincter, a ring of muscle that controls the anus.
5. Pressure reduction: The incision reduces pressure in the anal canal, allowing the fissure to heal.
6. Closure: The surgical site is closed using sutures or surgical glue.
7. Recovery room: The patient is moved to a recovery room to wake up from anaesthesia and be monitored for any complications.
8. Discharge: Once stable, the patient is discharged with instructions on wound care, pain management, and follow-up appointments.
9. Postoperative care: Continue with a high-fibre diet and stool softeners, and follow instructions on wound care.
10. Follow-up appointments: Attend follow-up appointments with the surgeon to monitor healing and address any concerns. ### Conditions Warranting Anal Fissure Surgery Anal fissure surgery is recommended for chronic anal fissures that have not healed with conservative treatments, such as dietary changes, medication, and sitz baths. Lifestyle factors, such as a history of constipation or recurrent episodes of diarrhoea, may also contribute to the need for surgery. ### Benefits of Anal Fissure Surgery The benefits of anal fissure surgery include pain relief, reduced bleeding, and improved quality of life. The surgery has a high success rate and can prevent complications such as anal spasms and abscesses. ### Risks of Anal Fissure Surgery Risks associated with anal fissure surgery include infection, bleeding, and temporary or permanent changes in bowel control. However, these risks are generally low. ### Preparation for Surgery Patients may be advised to follow a high-fibre diet, use stool softeners, and avoid straining during bowel movements before surgery. They may also need to undergo preoperative tests, such as blood tests and an electrocardiogram (ECG). ### Pre-surgery Procedures and Checks At the hospital, patients will be assessed by the surgical team, and their medical history will be reviewed. They may be asked to sign a consent form and will be given instructions on fasting and medication use. ### Postoperative Care After surgery, patients will receive pain relief medication and may be advised to continue with a high-fibre diet and stool softeners. They will be given instructions on wound care and follow-up appointments. ### Recovery and Rehabilitation Recovery from anal fissure surgery typically takes a few weeks. Patients may be advised to perform pelvic floor exercises to strengthen the muscles around the anus and promote healing. ### Alternatives to Surgery Non-surgical treatment options for anal fissures include dietary changes, medication, sitz baths, and Botox injections. These treatments may be effective for some patients, but surgery may be necessary if conservative measures fail. ## References
11. Anal Fissure. NHS. https://www.nhs.uk/conditions/anal-fissure/
12. Anal Fissure - Diagnosis and Treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351445
13. Anal Fissure. MedlinePlus. https://medlineplus.gov/ency/article/000209.htm
14. Anal Fissure. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/14428-anal-fissure
15. Anal Fissure. American Society of Colon & Rectal Surgeons. https://fascrs.org/patients/disease-condition/anal-fissure-expanded-information

• Anal Fissure. NHS. https://www.nhs.uk/conditions/anal-fissure/
• Anal Fissure - Diagnosis and Treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351445
• Anal Fissure. MedlinePlus. https://medlineplus.gov/ency/article/000209.htm
• Anal Fissure. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/14428-anal-fissure
• Anal Fissure. American Society of Colon & Rectal Surgeons. https://fascrs.org/patients/disease-condition/anal-fissure-expanded-information