When the sphincter muscles are contracted, they prevent anal fissures from healing. Sphincterotomy reduces tension and facilitates healing. An anal fissure is first treated with more conservative methods, including eating high-fiber food, drinking plenty of water, taking stool softeners, soaking in warm water, and applying topical medication. If these don’t work, surgery may be necessary. Surgery allows the wound to come together and heal and alleviates pain from the contraction of the sphincter muscles. It is an effective treatment that allows for fast healing for fissures.
 

Before the procedure you will undergo testing that includes blood and urine tests, chest x-ray, and electrocardiogram (EKG). You may also need additional testing depending on your health and what kind of anesthesia is used for the procedure. Pre-operative testing is usually done 2-3 days before the surgery.
If you take any blood thinners, including aspirin, you will need to stop these before the procedure. Please let your doctor know about all medications that you are taking and please bring all medication to the hospital on the day of the procedure.

If general anesthesia is used, you will need to fast, including gum and candy, from midnight on the day of the procedure. This is to reduce the risk of aspiration while under general anesthesia, though the risk is very low.
 

In a sphincterotomy, a small incision is made in the internal anal sphincter, one of the two muscles that control the anus. This temporarily reduces resting pressure of the anal sphincter, allowing the fissure to heal. The doctor will remove the injured tissue.

Surgery may be done with local or regional (spinal) anesthesia. In some cases, general anesthesia may need to be used. The decision regarding anesthesia will depend on the patient’s preference and health, the doctor’s comfort, and the regulations of the hospital.

You will be positioned on the operating bed so the doctor has comfortable access to your anus. You may either lie on your stomach with your hip slightly elevated or on your back with your legs in stirrups. The area to be operated on will be thoroughly disinfected before the procedure. The procedure takes approximately 20-30 minutes and the sutures placed are usually dissolvable. Most patients can go home after the procedure.
 

While you may experience some pain after the surgery, this can be managed with prescribed medication and should not last more than a few days. You will likely have some pain with bowel movements at first, but it should be less than what you felt before the surgery. You may also notice some blood on your toilet paper after a bowel movement for the first few weeks after surgery. This is normal. Be sure to eat high-fiber foods and drink plenty of water as well as take laxatives or stool softeners for more comfortable healing after surgery. Sitting in a warm bath after bowel movements can also help.

You should be able to return to your normal routine 1-2 weeks after surgery, but it can take up to 6 weeks for your anus to heal completely.
 

• Excessive bleeding
• Inability to control stool
• Urinary retention (inability to urinate)
• Infection
• Reaction to anesthesia
• Abscess or anal fistula

• If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.
• Travelers to Thailand should plan to stay in the country for at least 1 week or for the entire duration of treatment.
• If you plan to return home after the procedure, please speak to your doctor before making travel arrangements.
• During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).

The success of the procedure depends on a number of factors including the patient’s condition and self-care. Please discuss the likelihood of success with your doctor before the procedure.
 
What if the procedure is not performed?
The symptoms may become worse and the patient may not be able to do normal activities.
 

A sphincterotomy is often a last resort treatment in the case of chronic anal fissures that do not respond to other treatments.