What is sphincterotomy?

Lateral internal sphincterotomy is a type of surgery. It helps heal an anal fissure that hasn't improved with other treatments. An anal fissure is a tear in your anus.

You may be asleep during surgery. Or you may be awake. If you are awake, you will get medicine to help you relax. To do the surgery, the doctor puts a lighted tube into the anus. This is called a scope. It lets the doctor see the inside of the anus. Then the doctor puts special tools through the scope. They are used to make a cut (incision) in the ring of muscle that controls the anus. This ring of muscle is called your internal anal sphincter.

The surgery usually takes less than 30 minutes. Most people go home the same day.

For many people, the pain from their anal fissure goes away within several days. You will probably be able to go back to work and your usual activities in about 1 to 2 weeks. But it could take 6 weeks to completely heal.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Ask your doctor when you can drive again.
• Most people are able to return to work 1 to 2 weeks after surgery.
• Shower or take baths as usual. Pat your anal area dry with a towel when you are done.

Diet

• You can eat your normal diet. If your stomach is upset, try eating bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor has told you not to).
• It is important to eat high-fiber foods after your surgery. This will make it easier to have bowel movements.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• Pain medicine may cause constipation. Ask your doctor about taking a stool softener along with your pain medicine. Drink plenty of fluids.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Other instructions

• Sit in a few inches of warm water (sitz bath) for 15 to 20 minutes 3 times a day and after bowel movements. Then pat the area dry. Do this as long as you have pain in your anal area.
• Support your feet with a small step stool when you sit on the toilet. This helps flex your hips and places your pelvis in a squatting position. This can make bowel movements easier after surgery.
• Use baby wipes or medicated pads, such as Tucks, instead of toilet paper after a bowel movement. These products do not irritate the anus.
• Avoid using soaps with fragrance that can irritate the site.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Lateral internal sphincterotomy is surgery to help heal an anal fissure that has not improved with medicine or other treatments. Most people notice that the pain from an anal fissure goes away within a few days after the surgery.

You may be worried about having a bowel movement after your surgery. You will likely have some pain with bowel movements at first, but it should be less than what you had before the surgery. You may notice some blood on your toilet paper after you have a bowel movement for the first few weeks after surgery. You can make your bowel movements less painful by getting enough fiber and fluids and using stool softeners or laxatives. Sitting in warm water (sitz bath) after bowel movements will also help.

Most people can go back to work and their normal routine 1 to 2 weeks after surgery. It will probably take about 6 weeks for your anus to completely heal. Most people get better without any problems. But a small number of people have problems controlling stools when they pass gas. This usually gets better with time.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.
• You may need to empty your colon with an enema or laxative. Your doctor will tell you how to do this.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take about 30 minutes.