Different types of surgery may be done to treat anal fissures, such as lateral internal sphincterotomy, fissurectomy, and advancement flaps. The procedure may be repeated similarly or differently depending on the advice of the surgeon once the condition does persist. Skin around the anal fissure and internal anal sphincter muscles are involved in these kinds of surgeries; hence, pain around the anus, especially when going to the toilet, is normal a few days after any of the surgery.
To relax the internal anal sphincter, a small cut usually on the left or right side of the anus—from the distal most end of the anal verge which extends into the anal canal—is made by the surgeon in lateral internal sphincterotomy. There are doctors who prefer to cut the fissure during this procedure for lesser scarring and a decreased chance of stenosis when the wound heals. This procedure, although not always recommended for childbearing women and people with chronic diarrhea, is the common procedure used by the surgeons which heal anal fissures most of the time.
On the other hand, lateral internal sphincterotomy has 93% to 97% of fissures heal, with low recurrence of the anal fissure from 0% to 3%.
Another procedure called anal surgical stretch may also help alleviate pain and heal fissure; however, it is traumatic and only 72% of the fissures heal and 20% resulting to incontinence. This procedure is now less practiced by surgeons to treat anal fissures. After surgery, when the body still has difficulty in controlling evacuative functions which result to leakage of stool, fissurectomy may be advised by the surgeon, wherein the fissure will allow to heal on its own by removing all the damaged skin around it.
When the fissure does not heal, a section of a healthy skin from anal lining may replace the broken skin in the fissure. This latter procedure is known as advancement flaps or dermal flap coverage which reduce complication after surgery.
It is normal to develop anal incontinence and postsurgical pain after lateral internal sphincterotomy. Sometimes, there is even difficulty in controlling gas. Fecal soiling (when the stool stains the underwear) and fecal loss (which will require immediate changing of the underwear) may also result after the surgery, but the chances are low, with only 8% and 1% respectively of large series of patients followed for a mean of five years.
An anaesthetic is used during the surgery which will affect the person; therefore, rest is required and the patient is prohibited to drive, drink alcohol, or even sign anything, for coordination and awareness may be detrimentally affected by the anaesthesia. Painkillers may be given to the patient, but as all medicines to be taken, it will be necessary to consult first the doctor or the pharmacist.
Drinking lots of water, taking fiber supplements, or eating high-fiber foods, such as fruits, vegetables, and cereals, may be advised by doctors for easier bowel movement. Laxatives may also be given to avoid constipation. Washing gently after the defecation with soap and water should help. Use wet wipes for proper cleansing if there are no soap and water.
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