Dr. Kubrat Sajonia, proctologist at Top Doctors, will talk about anal fissure.
What is an anal fissure and what are the symptoms?
An anal fissure is a wound that occurs in the last part of the digestive tract, that is, in the anal region. People confuse fissure, fistula, hemorrhoids… each pathology in proctology has its own idiosyncrasy. As I said, a fissure is a wound. A wound that is characterized by intense pain, not so much at the time of bowel movement, but especially afterwards. Patients go to the bathroom and after ten minutes they start with a pain that is characterized by being very long lasting, that is to say, it is a pain that can last even for hours. A very intense pain that does not subside with any type of conventional painkiller.
What does anal fissure surgery consist of?
There are black legends about fissure surgery. The first is that it is an extremely painful surgery. This is absolutely false as long as you are operated on by someone who does it correctly. And the second is that patients who have fissure surgery become incontinent. This is also absolutely false and I would like to emphasize this because people put up with it, they do not have fissure surgery because they have been told that they are going to be incontinent. The surgery consists of making a tiny incision over one of the two sphincters that we have in the anal sphincter complex, specifically over the internal anal sphincter. When a patient has a fissure it is because he has an excess of muscle tone, an excess of strength in the sphincter. He will not be left with less strength than he needs, he will be left with the strength that corresponds. Fissures should always be treated first with medical treatment, and I would like to emphasize this. People are often mistakenly treated with hemorrhoid remedies. Fissures require a specific medical treatment based on muscle relaxant ointments, such as rectogesic or master formulas based on muscle relaxants. When the patient does not respond to medical treatment is when surgery should be performed. As I said, it is a delicate but not important operation, in which the patient is admitted for a few hours, it is performed under local anesthesia and sedation and is discharged the same morning of the operation.
What is the postoperative period and recovery like? Can it come out again?
The anal fissure operation, known as lateral internal sphincterotomy, is an operation performed under local anesthesia and sedation. It has a very simple postoperative period for the patient and it is not true that it is painful. The only thing it requires is hygiene, i.e. washing the wound with soap and water, and taking an antibiotic. The time off work never exceeds one week as long as there is no complication, such as wound infection. I always say that a patient operated on for a fissure the day after the operation is always better than when he/she had the fissure. Even after 2 – 3 days a patient could return to normal working life, without great discomfort. Many patients ask us if this procedure is definitive. The answer is yes. When a lateral internal sphincterotomy is performed correctly, it is practically impossible for the patient to have or develop a chronic anal fissure again.
In short, anal fissure surgery when performed correctly and with technological contributions such as a CO2 laser is an extremely resolutive surgery that practically does not affect the patient’s working life and he/she can return to work after 2 – 3 days.