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Surgery to treat chronic anal fissures

Surgeon and nurse suture a patient after lateral internal sphincterotomy procedure
A sphincterotomy, also known as a lateral internal sphincterotomy, is a procedure used to treat anal fissures. The operation involves cutting or stretching your anal sphincter to release tension and encourage your anal fissures to heal.

This type of surgery will only be recommended in cases of chronic anal fissures that have not healed even after using non-invasive treatments, or in cases where the symptoms of anal fissures are very severe.

If you are living with the difficult symptoms of chronic anal fissures and would like to speak to a specialist, call or book online today. Our experienced surgeons are ready and waiting to help you.

An anal fissure is a tear in the skin around the back passage, also known as your anal canal. Anal fissures are a common condition and symptoms include:

  • Sharp pain during bowel movements
  • Pain after your bowel movement, which might last several hours
  • Bleeding when you poo
  • Burning or itching in your anal area

Anal fissures are typically caused by damage to the lining of the anal canal, which most commonly happens as a result of constipation. Other causes of anal fissures include chronic diarrhoea, inflammatory bowel disease, pregnancy and childbirth.

If you are experiencing symptoms that you think might be an anal fissure, you should always speak to a doctor so that they can rule out other conditions, such as haemorrhoids (piles).

Most anal fissures will get better without treatment, however in some cases your internal anal sphincter might be particularly tight or might spasm a lot. This reduces the blood supply to the area and doesn't allow your fissures to fully heal. In this instance you will need treatment.

There are many alternative treatments for anal fissures and we won't typically recommend a sphincterotomy unless we have exhausted these other options.

The first recommended treatment of anal fissures will often be lifestyle changes, for example eating a high fibre diet and making sure you drink plenty of fluids, too. You might also be prescribed laxatives or stool softeners, and there are certain ointments that might ease your symptoms.

Many people find that a sitz bath can promote healing of their anal fissures. This is where you soak your bottom area in warm water with soothing salts in it. The bath cleanses, encourages blood flow and helps your muscles to relax, all of which help your fissures to heal.

One treatment for anal fissures is to use a special nitrate ointment to relax the sphincter muscle, reducing spasm and easing the pain, and allowing the fissure to heal. However, some people find applying the cream inconvenient or embarrassing, and it is possible to experience headaches as a side effect, which for a small number of people are so severe that they can't continue using it.

Certain injections, for example of botulinum toxin, can also be used as an alternative to surgery. These help to stop your anal sphincter muscle from spasming, which should reduce pain and allow for healing.

Sphincterotomy simply means dividing the sphincter. The purpose of internal anal sphincter surgery is to cut or stretch your sphincter so that tension in the muscle is released and it no longer spasms.

The operation is usually performed under a general anaesthetic and takes about a quarter of an hour.

Your surgeon will make a small cut in the skin near your back passage. They will then cut the lower part of the internal sphincter muscle. This will relieve the spasm in the sphincter, allowing a better blood supply to heal the fissure.

Once the procedure is complete, your surgeon will apply a dressing to the incision to stop bleeding. We will monitor you for a few hours to make sure everything has gone well.

You should be able to go home on the same day as your surgery, as soon as we are happy that everything has gone well.

The pain from the fissure should improve rapidly. It is usually possible to return to work after a few days, depending on your type of work. You might notice a little blood on your toilet paper when you poo. This is normal for the first few weeks.

Regular exercise should help you to return to normal activities as soon as possible. However, before you start exercising, ask your consultant or a member of your healthcare team for advice on how to safely get back to normal.

Most people make a full recovery and can return to normal activities. Occasionally the fissure comes back and you may need further treatment.

As with any surgical procedure, a sphincterotomy carries a small risk of complications. Your surgeon will explain all of these to you in detail before you decide to have surgery so that you are as informed and prepared as possible.

General complications that can happen with any operation include:

  • Pain
  • Bleeding
  • Infection in the surgical wound

Specific complications of this type of surgery include:

  • Involuntarily passing wind or loose faeces
  • Difficulty passing urine
  • Permanent incontinence from the bowel

The cost of a sphincterotomy depends on various factors including which hospital and which consultant you choose. If you would like a tailored quote, give one of our friendly advisors a call.

Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant's outpatient appointment consultation fee are charged separately.

Our flexible payment options help you spread the cost of your payment across a time period that suits you. We offer fixed-term monthly payment plans over one to five years with no deposit required. If you decide to pay over 10 months, you will pay interest-free. If you are paying for a longer period, you will pay 14.9% APR.

If you have private health insurance, sphincterotomy will usually be covered by your provider. Speak to your insurer directly to find out.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

  • Flexible appointment times and locations that are convenient for you
  • The freedom to choose which hospital and consultant suit your needs
  • Personalised, consultant-led treatment plans tailored to your individual needs
  • Comfortable and safe private facilities maintained by expert multidisciplinary teams
  • Private ensuite rooms as standard
  • A range of delicious healthy meals
  • Affordable, fixed-price packages with aftercare included
  • Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about sphincterotomy and other treatments for anal fissures, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in March 2023. Next review due March 2026.

  1. Internal anal sphincterotomy, NCBI
  2. Anal fissure, NHS
  3. Sphincterotomy, Healthline
  4. Anal sphincterotomy, One Healthcare

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