Anal fissure is a tear in the tissue lining the anus. It is a fairly common process and its symptoms of pain and bleeding are very uncomfortable for the patient, affecting his quality of life. Dr. Biondo is a specialist in the different treatment options for anal fistula, with more than 20 years of experience in coloproctology.
First of all, it is important to know that anal fistula responds up to 70% of the time to medical treatment, so that is usually the first option. When medical treatment has failed is when surgery should be proposed or evaluated.
Surgical techniques for anal fissure
There are several surgical options, depending on the patient and the type of fissure. Of all of them, the most successful technique is known as lateral internal sphincterotomy and consists of the partial section of the internal anal sphincter.
Other techniques can be considered depending on the characteristics of the patient, for example in patients with anal incontinence other techniques can be applied to cure the fissure without affecting anal continence, such as the application of botulinum toxin, fissurectomy or the “dermis graft” in the fissure.
When to operate on anal fissure
Any type of patient who has symptoms of anal fissure can be operated on. But medical treatment should always be tried as the first option.
Treatment of anal fissure consists of measures to avoid constipation: avoid alcohol and spicy foods, increase consumption of fruits, vegetables and cereals with fiber. The application of ointments to decrease anal sphincter tension as well as oral analgesics may also be prescribed.
If this treatment is unsuccessful, surgical treatment should be divided between patients at risk of incontinence or with incontinence already present and the group of patients without risk of incontinence. In patients without risk of incontinence the best option is lateral internal sphincterotomy, with 95% success. In patients at risk of incontinence, either other conservative treatment techniques or the group of alternative techniques already mentioned above, in which no part of the anal sphincter is sectioned, are chosen.
Pre-operative period before anal fissure surgery
Before the operation, no special care is necessary, it is simply essential to avoid the presence of diarrhea or hard stools by means of a diet rich in fiber and even a mild laxative.
Postoperative period and recovery from anal fissure surgery
Anal fissure surgery is not a particularly painful operation, so only the usual analgesics are prescribed.
The incision only requires the usual care, so the patient can usually return to activity within 48-72 hours. For a better recovery, it will be essential to avoid constipation.