What Is A Fissure?
A fissure occurs when the skin surrounding the anus is torn as the opening stretches during defecation. Anal fissures are common in people who suffer from constipation or inflammatory bowel disease. They are commonly associated with pain, spasms, bleeding, and skin tags called “piles” can develop.
Anal fissures occur if the external and internal anal sphincters fail to cooperate. Humans have the ability to contract or relax the external anal sphincter, but not the internal anal sphincter. Therefore, if the internal sphincter fails to relax during a bowel movement, the pressure in the anus builds and the constipation worsens making it harder to pass stool.
Anal fissures can be classified as either acute or chronic fissures. An acute fissure has formed recently, whereas a chronic fissure is one that has persisted over time. Therefore, a lateral internal sphincterotomy is a procedure used to repair chronic anal fissures.
Before The Procedure
Before the procedure is completed, the person is advised by the nurse or doctor to empty the bowels the day before in preparation for surgery. This will involve drinking a solution of magnesium citrate to soften the stool to stimulate a bowel movement, and drinking only clear fluids after lunch. On the actual morning of the procedure, two enemas are applied at least an hour before. Your healthcare professional will provide more information on how to prep before surgery with details specific to your case.
How The Procedure Is Completed
The procedure is actually quite straightforward. Using local anesthesia to numb the area, the surgeon will make a bilateral cut to the internal anal sphincter. The surgery will remove the fissure and as the sphincter muscle heals, it stretches the area making it easier to pass stool. In some cases, the surgeon can opt to use general anesthesia.
The person is placed either on their back with their feet in stirrups or face down. In either position is it necessary to provide the surgical team access to the anus. After cleaning, the surgeon then places a small cut into the sphincter muscle and this stretches the area allowing faecal matter to pass through without straining. The area where the fissure is removed is stitched with dissolvable stitches that break down over time. The whole procedure should last about half of an hour, and patients are then advised when they can be discharged.
The main complication associated with any surgical procedure is the risk of infection, especially as the incision is made in the anal area.
Web Source: British Medical Journal. “Lateral Subcutaneous Internal Sphincterotomy in Treatment of Anal Fissure.” 1970. Available: https://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1701817
Web Source: University of Wisconsin School of Medicine & Public Health. “Anal Fissure/Fistulotomy/Sphincterotomy Surgery.” 2009. Available: https://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-Show_Public_HFFY_1105646271830.html