Severe cases of anal fissure may require surgical operation but it is best to keep this as a last resort option of the worst case scenario. In other words, doctors are only expected to prescribe surgery if other interventions have failed.
Before Surgery
Before a patient is recommended to undergo surgery, they must first be subjected to a series of conservative treatments that comes in two phases.
The initial phase requires the patient to try natural methods that will allow the wound to heal naturally. Fissures in the anal region are typically caused by trauma induced by the pressure of contracting anal muscles during bowel movements. The first phase attempts to relieve the pressure off the anal muscles to allow the tear to heal by softening and adding bulk to the stool. In this part of the treatment, patients are advised to take in foods that are rich in fiber. Patients should constantly washing their perineum or the area between the anus and the vulva or scrotum to prevent infection.
If the initial phase failed to deliver, then the doctor may advise the patient to begin the second phase. After further inspection, the doctor will issue a prescription that allows the patient to buy medicine such as steroids and anesthetic ointments. If after a week, pain can still be felt in the anus and blood is still evident in the patient’s stool then the patient might just be recommended for surgery.
During Surgery
For anal fissures, the American Society of Colon and Rectal Surgeons recommends that a doctor must first subject the patient to a colonoscopy test to check which part of the anal sphincters warrants an operation. After pinpointing the torn area, the patients are asked to go on a fast at least 24 hours before the surgery.
The procedure that is ideal for anal fissure is called partial cross-internal sphincterotomy. This procedure cuts the anal sphincter to relieve pressure off the anal muscles and to relax the rectum thus decreasing the recurrence of pain allowing the tear to heal naturally. Another operational procedure involves the injection of Botox to the anal muscles. This should speed up the recovery of the tear in the anal lining.
Both procedures are typically same-day outpatient procedures. At most, 80% of patients who underwent Botox injection and 90% of patients who underwent sphincterotomy healed completely. Despite the odds of success, surgical operations involve some amount of risk including interference from dispelling gas and stool off the body.
Before performing the procedures, surgeons are required to inform the patients of the risk carried by the operations. The patients must listen closely to what the surgeons are saying to determine which of the above surgical treatment is more appropriate for their condition.
Recovery
Whether you underwent surgical or medical treatments, recovery period amounts to 2-3 months. Within this period, patients are advised to undergo a high-fiber diet and to refrain from activities that may put pressure to the anal muscles. If after four weeks, patients can still feel pain in the anal region and blood spots can still be found in their stool, they must consult their doctor immediately for further testing.
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