An anal fissure is a crack or tear in the anal canal. This bowel condition is usually caused by trauma. It can be categorized as chronic or acute. Acute anal fissure lasts for less than six months and may not need further treatment to completely heal. Most medical practitioners recommend non-surgical treatments for acute anal tears. The condition is just allowed to resolve on its own like a normal wound in the body. However, intake of pain killers, application of topical steroid cream, and having sitz baths may lessen the pain caused by the cut. On the other hand, chronic anal fissures have symptoms that last for more than six months. This type of anal ulcer may require more serious forms of treatment. These fissures do not heal over time and may need surgical attention. Lateral internal sphincterectomy is the gold standard in surgical treatment for chronic anal tears.
The anus is supported by internal and external anal sphincter muscles. Dysfunction of these muscles plays a big role in preventing the anal tear from healing. When a person is moving his bowel, the internal sphincter muscles automatically relaxes to allow the stool to exit the anus. After bowel movement, the internal sphincter muscles immediately goes back to their resting state to prevent fecal content from leaking out. If there is an anal tear, the internal sphincter muscles contracts more vigorously than normal. This pulls the edges of the tear apart and prevents them from healing. This is what usually happens to people with chronic anal fissure.
Lateral internal sphincterectomy is a surgical procedure wherein the surgeon makes a small incision on the internal sphincter muscles. The incision weakens the muscles and prevents them from contracting vigorously. Allowing the internal sphincter muscles to rest will allow more blood to flow to the affected area. This will help to rapidly heal the anal fissure.
The procedure can be done through open or closed technique. In the open technique, a cut is made between the lower portion of the rectum and the interior of the anal canal. This portion is known as the intersphincteric groove. When the internal sphincter muscles have already been separated from the anal tissue, they are then divided using surgical scissors. In the closed technique, an incision is also made in the intersphincteric groove. The next step is to advance the scalpel with the blade along the intersphincteric groove and then eventually divide the internal sphincter muscles. Dividing the muscles will lower their resting pressure. In both procedures, almost half of the lower portion of the muscles is divided. Both procedures are found to be effective in the treatment of the anal fissure. The incision can be sutured. Some surgeons leave the incision open and allows it to heal on its own. Local or general anesthesia may be used in the procedure. The patient can be positioned face down on the operating table or on lying position with both legs elevated on the stirrups. Both of these position allow the surgeon to clearly visualize the anal canal and its muscles.
The procedure only lasts for 20-30 minutes. This can be done as an outpatient procedure wherein the patient can go home on the same day and allowed to rest in his own home. The incision usually heals after 2-4 weeks. The patient is usually allowed to eat after the procedure. It is also very important to keep the surgical site clean to prevent infection. Mild bleeding should be normal for up to 10 days after the procedure.
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