What should you know before anal fissure surgery?

Anal fissure-a brief overview

When you have a tear on the tissue that surrounds your anus, the condition is known as an anal fissure. An anal fissure develops due to an overstretched anal tissue. Some of the causes of overstretched anal tissue include constipation, resulting in a hard bowel movement. Pregnant women are also at risk of an anal fissure which could develop during childbirth. Persistent diarrhea can also induce a tear on the tissues surrounding your anus, as you pass loose stool persistently. Inflammatory bowel disease such as Crohn’s disease may also trigger the development of an anal fissure, as do tumors and anal infections. However, such causes are quite rare.   

One of the defining symptoms of an anal fissure is experiencing sharp, persistent pain while having a bowel movement. Such pain could persist for up to a few hours. You are also likely to spot blood on your toilet paper while passing the stool. A close inspection of the anal tissues that surround your anus would reveal a visible tear. It is important that you consult our healthcare providers as soon as you observe any of these symptoms.

Your healthcare provider will conduct a physical exam and other relevant tests needed to make a formal diagnosis of anal fissure.  

A digital rectal exam using a speculum allows your doctor to have a better view of the anal area. Your doctor may also order a fecal occult blood test as this helps to reveal blood concealed in your stool. In case additional tests are required, your doctor might conduct a sigmoidoscopy or colonoscopy.

While some anal fissures do not require any treatment, or can heal with the aid of over-the-counter drugs, others do not heal so easily. They cause pain and suffering to the patient for weeks. Eventually, it becomes necessary that such a patient undergoes a surgical procedure.

Surgical treatment of anal fissures

While most anal fissures can be treated through non-surgical means, some chronic fissures are harder to treat. This calls for an aggressive mode of treatment, such as a surgical procedure. The objective is to aid in the relaxation of your anal sphincter muscles. Once relaxed, the spasms and pain brought about by an anal fissure reduce significantly. Consequently, this promotes the healing process.

The long-term outcome for surgery is good in over 90% of the patients. An anal fissure can be surgically treated using various surgical techniques. Some of the leading surgical techniques in use include:

Lateral sphincterotomy

In this surgical procedure, the surgeon makes a small cut on your sphincter. This is a ring-like muscle that adjoins the anal canal. The cut aids in relieving the pressure that has accumulated around this region. Once the pressure has subsided, healing begins. The procedure further minimizes the likelihood of you developing more fissures in the future. A lateral sphincterotomy is not complicated. A general anesthetic is all that you need prior to the actual surgery. You could leave the healthcare facility on the same day of the operation. The surgical operation is highly effective. For most patients, healing occurs in under 4 weeks.

A patient undergoing a lateral sphincterotomy might experience bowel incontinence, albeit temporarily. This is due to the damage sustained to their anal muscles. However, the probability of suffering such a complication is slim, occurring in less than 1 person out of every 20 people who undergo a lateral sphincterotomy. Since this complication interferes with your quality of life, there is a need to discuss it with the surgical team.

Contraindications and risks

Most people who undergo a sphincterotomy report being satisfied with the procedure. The success rate for a sphincterotomy is also high. Nonetheless, the surgical procedure is also prone to several risks, just like any other type of surgery. A sphincterotomy may present with the following complications:

Temporary incontinence:

Few patients might experience incontinence a few weeks after surgery. Such incontinence may be accompanied by an inability to control gas. The patient may also experience leakage of stool. Nonetheless, this incontinence is short-lived and will clear on its own within 2 weeks.

Hemorrhage

Some patients may also experience bleeding following a surgical procedure. However, the complications are very rare. In the unlikely event that you experience hemorrhage, the surgeon may have to use certain stitches or sutures.

Perianal abscess

If the surgical operation that you underwent was a closed technique, there is a slim possibility of an abscess forming. This collection of pus forms as the anal fistula also develops. In such a case, it becomes necessary to drain the abscess. Your surgeon may further recommend that you undergo a fistulotomy. The purpose of this technique is to remove the fistula.

Prior to the surgery

Being a minor procedure, your surgeon will guide you on what to expect while preparing for a sphincterotomy. If the surgeon has suggested general anesthesia and both of you are in agreement, it is advisable that you do not drink or eat anything past midnight prior to the procedure. In the case of a local anesthetic, the instructions are the same. However, you may be allowed to drink and eat up to a few hours before the surgery.

If you are on blood thinners or related medication, you may be advised to stop taking this medication for a few days prior to the surgery. For this reason, it is important that you inform your surgeon of all the supplements or medication that you may be on, well in advance.

Anal advanced flaps

This procedure entails repairing an anal fissure with healthy tissues obtained from a different part of the body. The goal is to ensure that the site of the fissure experiences increased blood flow. Besides covering the defect, an advancement flap promotes healing. It also avoids the risk of fecal incontinence brought about by an anal fissure. The procedure is applicable to patients in whom the affected anal muscle is significant. Other patients who have weakened anal and pelvic floor muscles, may also benefit from an anal advanced flap. They include mothers who overstretched their anal tissue during childbirth.

The technique is not without its fair share of complications, such as infections. This is influenced by factors such as obstetric trauma, age, and anorectal surgery.

How is it done ?

The procedure entails taking healthy tissues from a different body part. The healthy tissues act as the raw material for repairing the fissure. In other words, the procedure involves removing the chronic tissues that have shown no signs of healing and replacing them with healthy tissue to hasten the healing process. The procedure is also beneficial to those who underwent a sphincterotomy but have recurrent fissures.

The procedure is conducted either under local or general anesthesia. On the day that you are scheduled to undergo this surgical procedure, your surgeon may deem it necessary to administer an enema. This helps in clearing your bowel. The procedure is simple and takes about 1 hour. The surgeon has to identify and create a flap of skin. It is also important that the flap be obtained from healthy tissue, as it is going to replace a diseased one. The surgeon then moves this flap of skin to the area affected by the fissure and covers it to promote healing.

The procedure has an estimated success rate of nearly 60%. However, there is a risk that the wound we seek to cover could open up. There is also the risk of a wound developing on the fissure area that we have covered. For this reason, we advise our patients to desist from sitting on the wound for at least 14 days. This will also give us time to assess how the wound is healing. Our surgeons are always on call. Feel free to contact them anytime in case you get worried about the possibility of the wound opening.

Other complications that may accompany this procedure include the formation of blood clots, urinary retention, and bleeding

Recovery

All the above procedures are performed under anesthesia. Our surgeons also prefer performing these procedures as day case operations to minimize admission at the health care facility overnight. However, at times, it may be necessary to retain some of the patients so that we can observe them further.

If we ascertain that you can eat and drink after the procedure and that you can walk without any assistance following the surgery, then we can allow you to go home. We may also have to ascertain that you can pass urine and that the pain after surgery is manageable. Doctors prescribe pain killers to help you handle pain after getting back home. We also recommend that you take laxatives for about one month post-op. Ensure that your motions remain soft. Patients who have undergone an anal advanced flap operation take about 3 weeks to recover fully. However, the recovery process also depends on individual patients.

Laser surgery for anal fissures

It is now possible to treat anal fissures using laser surgery, due to advancements in technology. The procedure is simple to administer, often under local anesthesia. Postoperative morbidity associated with laser treatment for fissures is also very low, compared to other surgical procedures. Additionally, laser treatment for fissures is characterized by a limited rate of recurrence, relative to other conventional surgeries.

The procedure entails the application of a CO2 laser. The laser emits infrared radiation which helps to improve the flow of blood to the area where the fissure is located. Consequently, this leads to proper healing. The application of CO2 laser enables more control to the surgeon during surgery.  Some of the other benefits of using laser surgery over other surgeries include:

• It is less invasive unlike the traditional surgical techniques
• It is simple to administer while the recovery rate is faster

Post-op care

We maintain ongoing communication with patients even after discharge, following fissure surgery. This is important to ascertain that healing is taking place normally and that the patient is adhering to the advice. Protect against constipation by keeping away from foods that can trigger this condition. Example of such foods includes fatty and spicy food.

Sitz baths taken about thrice a day for about 20 minutes helps to improve bowel movement. You must desist from engaging in any strenuous activity for at least 7 days post-operation. Ensure your diet is rich in green leafy vegetables and fruits as these provide the much-needed dietary fiber. Increase your daily intake of fluids, especially water. In case you develop a high fever, call us immediately.

Make sure to honor follow-up appointments so that we can assess your progress after the surgery.

Prevention of recurrence

Be cautious to minimize the risk of recurrence following treatment of an anal fissure. You can do this by:

• Liaising with your dieticians on the recommended dietary intake.
• Staying hydrated by drinking 6-8 glasses of water daily
• If the doctor has prescribed any medication, make sure you take it all
• Stay away from spicy foods and other foods that could exacerbate your symptoms
• Develop a daily routine for having a bowel movement

At goficure, we offer the following services to patients needing treatment for anal fissures.

We help you –

• Connect with highly skilled and experienced surgeons
• With a full healthcare package from scheduling an appointment at a hospital, to consultation and surgery.
• By handling the complete logistics of pick up and drop during consultation, surgery and post-op care
• Processing the insurance claim after the procedure
• With the best price and discounts on consultation fee.
• By scheduling follow up appointments with the surgeon
• By taking charge of post-operative care
• With daily nutritive meal plans, lifestyle modifications , medications to help the healing and recovery process

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