Surgical Treatment Options for Anal Fissures

surgical treatment for anal fissure

An anal fissure is a small tear in the lining of the anus. Typically the tear happens due to severe constipation when a person tries to pass hard and large stools. Streaks of blood can be seen on the stool passed or on the tissues that are used to wipe the person’s bottom. Anal fissures heal on their own in a period of six to eight weeks. If the fissure(s) doesn’t heal within that period, you need to see a good gastroenterologist or a urologist.

There are plenty of ways how one can prevent him/herself from getting anal fissures and you can read through the following article to know about them in detail >> Ways to prevent Anal Fissure

In here, let us look at some treatment options (surgical and non-surgical) that are employed by doctors to treat anal fissures.

Treatment of Anal Fissures

Anal fissures also form when the muscles around the anus, called the sphincter muscles spasm up or get tensed. When this happens, they cut the blood flow to the fissure area thereby obstructing the healing of fissures. If the person is also suffering from constipation, the condition gets worse and he/she may end up seeing a specialist.

Initially, the doctor may put you on to medication, creams or laxatives to ease the passage of stools. When that doesn’t work, any of the following treatment approaches for fissures may be taken as per his/her diagnosis of the problem:

Botox Injections

Injecting Botox (Botulinum Toxin) is a daycare procedure done at the doctor’s clinic. You need not get admitted to getting this treatment done. This will be the first procedure opted by surgeons before opting for other procedures.  This procedure is done under general anesthesia.  Botox is injected directly into the anal sphincter muscles. The aim is to relax the sphincter muscles and allow good blood supply to the fissures to heal quicker.

How effective is Botox treatment for fissure?

70% of the time, this works and the patient is healed completely. Some may need to go for a second shot after a few months to achieve complete healing.  In a few patients, fissures return after a couple of years after this treatment.

Risks associated with Botox treatment for fissures:

  1. Side effects of using Botox injections for fissures are that the person will not able to hold gas and may lose control of bowel movements (faecal incontinence). This is only a temporary effect and the person will become normal after the effects of Botox wane.
  2. In rare cases, the Botox can spread to other muscles making them weak and can also cause difficulty in breathing.

If you are experiencing any of these symptoms after undergoing the Botox therapy, you must talk to your doctor and check if these are normal. Generally, the doctor would advise on these side effects and also lets the patient know what is normal and what is not.

Fissurectomy

At times, the doctor may suggest fissurectomy along with Botox. In this procedure, the damaged skin from around the fissure is removed along with the ‘sentinel’ skin tags.

Sentinel skin refers to the lumps of skin associated with the fissure.

Lateral internal sphincterotomy

Sphincter muscles are present around the anus. They contract and relax as per the signals received during bowel movements. In people whose sphincter muscles spasm up, it becomes difficult for the anal fissures to heal due to low blood supply caused by the muscle spasms.

Sphincterotomy is a procedure where a small part of the sphincter muscle is cut in order to let the fissures heal. This procedure is employed by specialists when other treatment options are of very little help.  This procedure is done under general anesthesia. Sphincterotomy is performed in two ways. In an open sphincterotomy, the surgeon makes a small incision on the skin to reach the sphincter muscles. This enables him/her to directly see the muscle when they cut it. The cut on the skin will be left open to heal on its own. In closed sphincterotomy, the surgeon passes a blade under the skin to reach and cut the sphincter muscle.

Effectiveness of sphincterotomy – This is an effective procedure that works in around 95% of the patients.

Drawbacks of sphincterotomy:

  1. This procedure can lead to incontinence in 20 to 30% of the cases. As the sphincter muscle is cut, the person loses control of the bowel movement partially resulting in fecal incontinence. Also, the person will have little control over passing gas.  This problem goes away after a few months in many patients but will stay back in a few of them.
  2. As with any surgery, the risk of infection remains in this surgery. An abscess (collection of pus) may also form which will be treated by draining the puss and putting the person on antibiotics.
  3. In 1-2% of the cases, the anal fistula may form because of cutting the sphincter muscles.

Anal advancement flaps

This procedure involves replacing the torn skin on the fissure with the healthy skin that is removed from the anal lining. The healthy skin will be sutured on to the fissure. This procedure is not chosen often. Usually, specialists opt for this procedure when he/she suspects the possibility of incontinence if he/she goes for sphincterotomy.

Which surgery is the best for treating anal fissures?

Your surgeon will explain to you all the options he/she has after examining the fissure. He/she will detail all the pros and cons of each procedure. You can take a call or go with the doctor’s advice. Or you can even go for a second opinion from another urologist or gastroenterologist you trust. Or you can continue with creams, laxatives, etc for some more time.  Usually, it is best to leave it to the specialist to determine which surgery is the best to treat your anal fistula problem.

If you are suffering from anal fissures for a long time or if you need a second opinion after visiting a doctor previously, you can call us for an appointment. The gastroenterologists at ‘The Laser Gastroenterology Clinic’ are highly trained and come with 20+ years of experience in the field.

Dr. Karthik Gunasekaran