What is Anal Fissure Surgery?
BDS (Bachelor of Dental Surgery), 10 years of experience
What is the meaning of Anal Fissure Surgery?
Anal Fissure surgery is a procedure done to repair the tear in the lining of the anus or the anal canal (the opening through which stool is excreted from the body), which is known as an anal fissure.
Anal fissures can cause pain during a bowel movement or after a bowel movement and may cause bleeding.
In this article, we will be discussing in detail about anal fissure and anal fissure surgery.
- What is the purpose of Anal Fissure Surgery?
- What are the symptoms that indicate the need for Anal Fissure Surgery?
- What is the diagnostic procedure before Anal Fissure Surgery?
- What is the preparation for Anal Fissure Surgery?
- What are the different types of treatments for Anal Fissures?
- What is the procedure of Anal Fissure Surgery?
- How to care after Anal Fissure Surgery?
- What are the complications of Anal Fissure Surgery?
- How to prevent Anal Fissures?
- What is the cost of Anal Fissure Surgery in India?
What is the purpose of Anal Fissure Surgery?
The following can cause anal fissures and may require an anal fissure surgery if all other treatment methods fail:
- Prolonged period of constipation
( Know more about- What is Constipation? Causes, Symptoms, Treatment )
- Straining while having a bowel movement
- Dry or hard stools which are difficult to pass
- Injury or trauma to the anus
- Anal sex
- Diarrhea
- Childbirth
- Inserting foreign objects into the anus
- Scars in the anal or rectal (rectum is a continuation of the colon or the large intestine and connects to the anus) region
- Spasm or tightening of the anal sphincter muscles (muscles controlling the opening and closing of the anus)
- Decrease in blood flow to the anal region
Presence of underlying medical conditions like:
- Inflammatory bowel diseases like Crohn’s disease and ulcerative colitis
- Cancer of the anus
- Blood cancer (Leukaemia)
- Infectious diseases like tuberculosis
- Sexually transmitted diseases like HIV, gonorrhea, syphilis, chlamydia
( Know more about- What is Ulcerative Colitis? Causes, Symptoms, Treatment, Prevention)
What are the symptoms that indicate the need for Anal Fissure Surgery?
The symptoms commonly associated with an anal fissure, which may require an anal fissure surgery are:
- Pain during bowel movements
- Pain after a bowel movement
- Constipation
- Blood in stools
(Know more about- What is Blood in stools? Causes, Symptoms, Treatment, Prevention )
- Tear in the anus or anal canal
- Itching in the anal region
- Burning sensation in the anal region
- Discharge with a foul smell
- Increase in frequency of defecation or inability in defecation or passing stools
( Know more about- What is Colon Infection? Causes, Symptoms and Treatment )
What is the diagnostic procedure before Anal Fissure Surgery?
- Physical exam:
- The doctor will first do a physical examination, which includes an inspection of the anus and the area around it. The anal tear is usually visible and is enough to diagnose an anal fissure.
- An acute (sudden and short-term) anal fissure looks like a paper cut and is a fresh tear.
- A chronic (gradual and long-term) anal fissure which lasts more than 8 weeks has a deeper anal cut and may have external or internal fleshy growths.
- If the fissure is located on the side of the opening of the anus, it is most likely a sign of another disease such as Crohn’s disease.
- The doctor may recommend the following tests if he suspects an underlying disorder:
- Anoscopy: A tubular device known as an anoscope is inserted into the anus to visualize the anus and the rectum.
- Flexible sigmoidoscopy: A thin, flexible tube with a camera on one end is inserted into the bottom part of the colon (large intestine). This test can be done in people less than 50 years of age, who have no risk factors for colon cancer or diseases of the intestine.
- Colonoscopy: A flexible tube is inserted into the rectum for the inspection of the colon. This test is done in people over 50 years of age, or in people with risk factors for colon cancer, other disorders, or symptoms like stomach pain and diarrhea.
( Know more about- What is Colonoscopy? Causes, Procedure, Risks, Cost )
What is the preparation for Anal Fissure Surgery?
- The patient should inform the doctor of any pre-existing medical conditions he may be having.
- The patient should inform the doctor of any medications or supplements that he may be taking.
- The doctor may ask the patient to stop any blood-thinning medications like aspirin he may be taking a few days before the surgery, as these medicines increase the risk of bleeding.
- The patient is instructed to not eat or drink anything after midnight the day before the surgery.
- Stop smoking at least two weeks before the surgery.
- Have someone to take you home after the surgery.
- The doctor may prescribe a laxative (medicine given to empty the bowels) or enema (a fluid is injected into the lower bowel through the rectum) to empty the colon before the surgery.
( Know more about- What is Hernia Surgery? Causes,Diagnosis, Procedure, Aftercare, Cost)
What are the different types of treatments for Anal Fissures?
The different types of treatment for Anal Fissures include:
Non-surgical treatment:
- Hydrocortisone (corticosteroid) containing foams, creams, or suppositories can be used to reduce inflammation.
- Application of other types of creams and ointments help in the treatment of anal fissures. For example,
- A medicated cream helps in healing the anal fissure
- A topical muscle relaxant can be used for relaxation of the anal muscles
- A nitroglycerin or calcium channel blocker ointment is used for the relaxation of the anal muscles and increase the rate of healing by providing blood flow to the anorectal region
- An anesthetic ointment will reduce the pain that may be interfering with a bowel movement.
- Botox (botulinum toxin type A) injection is given into the anal sphincter. This injection will paralyze the anal sphincter muscle temporarily, giving pain relief and helping in the healing of the anus area.
- Surgery: When the conservative, non-medical approach has failed the doctor may perform surgery to treat the anal fissure.
( Know more about- What is Piles Surgery? Causes, Procedure, Aftercare, Cost )
What is the procedure of Anal Fissure Surgery?
Anal fissure surgery is generally performed under general anesthesia. The following surgical procedures can be performed to treat anal fissures:
- Lateral internal sphincterotomy
- In this procedure, the sphincter muscles are cut from the outermost edge of the anus allowing the anal fissure to heal.
- This procedure can be done in two ways:
- Open sphincterotomy: In this procedure, the surgeon makes a small incision (cut) in the skin to view the sphincter muscles. This cut is usually left open for healing.
- Closed sphincterotomy: The surgeon passes a blade under the skin to reach the sphincter muscles and then cuts them in this procedure.
- The main disadvantage of this procedure is the development of incontinence (lack of control over urination) in patients.
- Fissurectomy
-
- The edges of the fissure are surgically removed in this procedure, along with any skin tags that may have occurred along with anal tears. The sphincter muscle is not cut in this procedure.
- A cauterization tool is later used to seal the entire wound area.
- Lateral internal sphincterotomy is preferred over fissurectomy as pain relief is immediate with sphincterotomy as compared to gradual pain relief obtained by fissurectomy. Also, the anal fissure recurrence is higher after a fissurectomy.
- Anal advancement flaps
- The surgeon takes a small part of healthy skin and grafts it in the place of the damaged skin in the fissure in this procedure.
- The procedure is not as effective as sphincterotomy, but is less likely to cause incontinence in patients.
- Laser surgery for anal fissure treatment
- This surgery can be performed under local anesthesia.
- A carbon dioxide (CO2) laser is generally used. This laser can be used to concentrate on a fixed area of the surgery and more control over the surgery.
- The laser’s infrared radiation is used for increasing the blood flow to the anal fissure area. This allows the proper healing of the fissure.
- The healing is faster and the chances of recurrence of the fissure are less when treated using laser surgery.
( Know more about- What is Appendix Surgery? Causes, Tests, Procedure, Aftercare, Cost )
How to care after Anal Fissure Surgery?
- It is normal to have some pain for 24 to 48 hours post-surgery. The doctor will prescribe pain medications to take care of the pain.
- Bleeding and constipation are commonly observed for the first few days after the surgery. One should avoid straining while passing stools.
- The patient should not lift anything heavy for 1 or 2 days after the surgery.
- Most patients can go back to work about two weeks after the surgery. Although, complete healing can take about six to ten weeks.
( Know more about- What are the Benefits of Green Leafy Vegetables ?)
What are the complications of Anal Fissure Surgery?
Like any other surgery, anal fissure surgery may also have
- Fever
- Chills
- Inability to urinate
- Blood in stools
- Prolonged pain
- Dizziness
- Fainting
- Increased bleeding
- Blood clot formation
- Pus discharge
The patient should immediately contact a doctor if any of the above symptoms are seen.
( Know more about- What is Dizziness? Home Remedies for Dizziness )
How to prevent Anal Fissures?
- Constipation can be avoided by using a stool softener, avoiding caffeinated drinks, drinking lots of fluids, and having a fiber-rich diet.
- Soaking in a warm water bath for 10 to 20 minutes, many times a day helps in the relaxation of the anal muscles.
- Clean the anorectal area gently.
- One should avoid straining while passing stools.
- Petroleum jelly can be used for lubricating the anorectal region.
( Know more about- What is Acid Reflux? Causes, Symptoms, Treatment, Prevention )
What is the cost of Anal Fissure Surgery in India?
The total cost of anal fissure surgery in India can range from around INR 20,000 to INR 1,50,000. However, many prominent hospital doctors in India specialize in anal fissure surgery. But the cost varies across different hospitals.
If you are coming from abroad, apart from the cost of anal fissure surgery, there will be an additional cost of living in a hotel and the cost of local travel. After surgery, the patient is kept for two days in the hospital and five days in the hotel for recovery. So, total cost of anal fissure surgery comes to be around INR 30,000 to INR 2,00,000.
We hope that we could answer all your questions regarding Anal Fissure Surgery through this article.
If you need more information and treatment of Anal Fissure Surgery, you can contact a Surgical Gastroenterologist.
We only aim to provide you with information through this article. We do not recommend any medication or treatment to anyone. Only a qualified doctor can give you good advice and the correct treatment plan.
