Anal Fissure Surgery

Initial consultation

During your initial consultation for anal fissure surgery, your colorectal surgeon will talk to you in detail to understand the severity of your symptoms and determine the best course of action. They will review your medical history, including any previous treatments you have tried and ask about current symptoms like pain, bleeding or discomfort during bowel movements. A gentle physical examination will be done to inspect the area and assess the fissure. In some cases, the doctor may recommend further testing, like anoscopy, to get a clearer view. Your surgeon will explain the surgical procedure (usually initially a Botox injection, proceding to a lateral anal sphincterotomy if this fails) and its benefits, risks and what to expect during recovery. This is also a great time to ask questions, share your concerns and make sure you are comfortable with the treatment plan.

Preparation for anal fissure surgery

Preparation is key to a smooth surgical experience and recovery. Before anal fissure surgery, you will need to follow specific instructions given by your doctor. These may include diet changes, stopping certain medications and other personalised instructions. One important step in preparation is to discuss anaesthesia options with your doctor. Depending on your health and preferences, you may choose a regional or general anaesthesia. You will also need to arrange for transportation after the surgery, especially if general anaesthesia is used, as you won’t be able to drive yourself home.

Bowel preparation is not usually needed for procedures like lateral anal sphincterotomy making the preparation process relatively easy compared to other surgeries involving the bowels, rectum and anal canal. Following these steps can make a big difference to your surgery and recovery.

The procedure

Anal fissure surgery is aimed to relieve tension in the anal sphincter, helping it to heal. By relaxing the muscle and improving blood flow to the area, the procedure relieves pain and supports tissue repair. It’s usually a short procedure, and most patients can go home the same day to start their recovery.

Types of anal fissure surgery

There are several surgical options available, each suited to different severities and underlying causes of the fissure. The most common procedure is botulinum toxin (Botox) injection, which aims to relax the anal sphincter muscle and reduce spasm.

A less common but more effective procedure is lateral anal sphincterotomy, which involves a small incision in the internal anal sphincter, again reducing pressure in the muscle to encourage healing of the fissure.

An alternative surgical treatment is advancement flap surgery. This involves using healthy tissue (usually from a nearby area) to cover and repair the fissure, improve blood flow and promote robust healing.

Lateral anal sphincterotomy

This is the most effective procedure for chronic anal fissures. Under general anaesthesia, the surgeon makes a small incision in the internal anal sphincter muscle to release the pressure that hinders healing.

The success rate is high, with around 95% of patients experiencing significant symptom relief. While generally safe, the procedure has a low risk of anal leakage after surgery.

Advancement flap surgery

Used for complex or non-healing fissures, advancement flap surgery replaces damaged tissue with healthy, well-vascularised skin to improve healing conditions. It’s particularly useful for cases related to childbirth or trauma where surrounding tissue may be compromised. Its strength lies in restoring integrity and blood flow to the area.

Post-surgery care

Good post-operative care is crucial for a smooth recovery and to minimise complications. Warm sitz baths (ideally three times a day) are recommended to reduce pain and promote healing. Applying topical creams after each bath can help the recovery process, especially during the first week when wounds are most fragile.

Constipation is a common side effect of pain medication, so managing bowel health is important. Increasing fibre intake, using stool softeners and possibly taking mild laxatives can help maintain soft stools and ease bowel movements. If sitting is necessary, avoid sitting for extended periods; if sitting is unavoidable, a foam cushion can be helpful. Over-the-counter pain relievers can be used as needed.

Some bleeding during bowel movements is normal in the early stages of recovery. However, if you notice persistent or worsening bright red bleeding, contact your care team or surgeon immediately. Following these guidelines can make a big difference to healing and your recovery.

Long-term recovery and follow-up

Most patients will experience pain relief soon after a lateral sphincterotomy, and full healing usually takes 4 to 6 weeks. A follow-up appointment is usually scheduled 1 to 2 months post-surgery to check healing. Additional check-ins aren’t usually needed unless issues arise or your surgeon advises otherwise.

During long-term recovery, return to normal activities gradually and listen to your body. Many patients take a few days off work, depending on their comfort and the nature of their job. Recurrence of anal fissures is uncommon and usually related to incomplete healing or underlying conditions.

Risks and complications

As with any surgery, anal fissure procedures have some risks. The most common short-term issue is mild bowel control difficulty, affecting almost half of the patients, though this usually resolves as healing progresses. There is also a small risk of incontinence, post-operative bleeding or infection, though long-term complications affect less than 5% of patients. Knowing these potential issues helps to set realistic expectations and take preventive measures during recovery. Contact your care team if you have any unusual symptoms.

Success rates and prognosis

Anal fissure surgery has high success rates, over 90% of patients have long term relief and return to normal daily activities. Overall, the outlook for patients undergoing surgery is excellent, most will see an improvement to their quality of life.