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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
What is endoscopic sphincterotomy?
Although we primarily perform lateral internal sphincterotomies for anal fissures, it's important to understand different types of sphincterotomies:
Endoscopic sphincterotomy is a procedure used to treat problems with the bile ducts or pancreas. It involves:
- Using an endoscope (a thin, flexible tube with a camera) to access the bile duct
- Cutting the sphincter muscle at the junction of the bile duct and small intestine
- Allowing better drainage of bile or removal of gallstones
This procedure differs from the lateral internal sphincterotomy we offer for anal fissures. If you have concerns about bile duct issues, we recommend discussing these with one of our gastroenterology specialists.
What is a lateral sphincterotomy?
A lateral sphincterotomy is our primary surgical treatment for chronic anal fissures. Here's what you should know:
- It's a procedure to partially cut the internal anal sphincter muscle
- The goal is to reduce muscle tension and improve blood flow to the fissure
- It's typically performed under general anaesthesia
- The procedure usually takes about 15 minutes
- Most patients can go home the same day
This surgery is only recommended when more conservative treatments haven't been successful. Our experienced surgeons will discuss whether this is the right option for you during your consultation.
What is biliary sphincterotomy?
A biliary sphincterotomy is:
- A procedure to cut the sphincter muscle controlling the opening of the bile duct
- Usually performed during an ERCP (Endoscopic Retrograde Cholangiopancreatography)
- Used to treat conditions like gallstones or bile duct strictures
- Not related to the treatment of anal fissures
If you're experiencing issues related to your bile ducts or gallbladder, we recommend speaking with one of our gastroenterology specialists for guidance and treatment options.
What is a sphincterotomy ERCP?
It's valuable to understand other types of sphincterotomies. A sphincterotomy ERCP refers to:
- A procedure performed during an Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Cutting of the sphincter muscle at the junction of the bile duct and small intestine
- Used to treat biliary system issues, not anal fissures
This procedure is different from the lateral internal sphincterotomy we offer for anal fissures. If you have concerns about bile duct problems, please consult with one of our gastroenterology specialists.
What is a sphincterotomy of bile duct?
A sphincterotomy of the bile duct:
- Is a procedure to cut the sphincter muscle controlling the bile duct opening
- Is typically performed during an ERCP procedure
- Helps to remove gallstones or improve bile drainage
- Is not related to the treatment of anal fissures
For bile duct issues, we recommend consulting with one of our gastroenterology specialists who can provide the right advice and treatment options.
How long does a sphincterotomy surgery take?
At Circle Health Group, we understand that knowing the duration of your procedure is important. For a lateral internal sphincterotomy:
- The operation typically takes about 15 minutes
- You'll be under general anaesthesia during this time
- The total time in the operating room may be longer, including preparation and recovery
Remember, while the procedure itself is relatively quick, we'll keep you under observation for a few hours afterwards to ensure everything has gone well before you're discharged.
Are you put to sleep for a sphincterotomy?
We prioritise your comfort during procedures at Circle Health Group. For a lateral internal sphincterotomy:
- The operation is usually performed under general anaesthesia
- This means you'll be asleep and won't feel anything during the procedure
- In some cases, regional anaesthesia might be used instead
Your consultant will discuss the most appropriate anaesthesia option for you during your pre-operative consultation, taking into consideration your medical history.
Is a sphincterotomy permanent?
We aim to provide long-lasting relief from anal fissures. Regarding how permanent a sphincterotomy is:
- The cut made to the sphincter muscle is permanent
- For most patients, this provides long-term relief from anal fissure symptoms
- In some cases, fissures may recur and require further treatment
While the procedure itself is permanent, it doesn't prevent new fissures from potentially forming in the future. We'll always provide you with advice on how to maintain good anal health to reduce the risk of recurrence.
Is lateral internal sphincterotomy painful?
We strive to make your experience as comfortable as possible. When it comes to pain after a lateral internal sphincterotomy:
- The procedure itself is performed under anaesthesia, so you won't feel pain during surgery
- Post-operative pain is usually mild to moderate
- Most patients experience rapid improvement in their anal fissure pain
- Any surgical pain typically subsides within a few days to a week
We'll provide you with appropriate pain management strategies and medications to ensure your comfort during recovery. If you have concerns about pain, don't hesitate to discuss them with your healthcare team.
What are the disadvantages of sphincterotomy?
At Circle Health Group, we believe in fully informing our patients about their procedures. While sphincterotomy is generally safe and effective, potential disadvantages include:
- Risk of temporary or permanent incontinence (usually minor)
- Potential for infection or bleeding
- Possibility of fissure recurrence
- Short period of recovery and activity restriction
Your consultant will discuss these potential risks in detail during your consultation, ensuring you can make an informed decision about your treatment.
How do you poop after sphincterotomy?
After a sphincterotomy, we provide guidance on bowel movements:
- You may experience some discomfort during the first few bowel movements
- We often recommend stool softeners to make bowel movements easier
- Maintaining a high-fibre diet and staying hydrated can help
- Gentle cleaning with warm water after bowel movements is advised
- Avoid straining during bowel movements
Our aftercare team will provide you with detailed post-operative instructions to ensure a smooth recovery and comfortable bowel movements.
How do you pee after fissure surgery?
We understand common concerns about urinating after your operation. After a sphincterotomy:
- Most patients can urinate normally soon after surgery
- Some may experience temporary difficulty urinating due to anaesthesia effects
- If you have trouble urinating, inform your healthcare team immediately
- Staying hydrated can help promote normal urination
If you experience any persistent problems with urination, don't hesitate to contact your healthcare team for advice as soon as possible.
Do you get stitches with a sphincterotomy?
Our approach to sphincterotomy typically involves:
- Small incisions that often don't require stitches
- If stitches are used, they're usually dissolvable
- A dressing is applied to the incision site to stop bleeding
Your surgeon will use the most appropriate technique for your individual case. They'll inform you about the specific details of your procedure, including whether stitches will be used, during your consultation.
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 September 2024. Next review due September 2027.
- Internal anal sphincterotomy, NCBI
- Anal fissure, NHS
- Sphincterotomy, Healthline
- Anal sphincterotomy, One Healthcare
- Lateral internal sphincterotomy, JAMA Network
- Lateral internal sphincterotomy, Cleveland Clinic
- Sphincterotomy, Healthline
- ERCP (endoscopic retrograde cholangio pancreatography), Guys and St Thomas, NHS
- Anal fissure, NHS
- Endoscopic Sphincterotomy, Medscape
- What Is a Biliary Endoscopic Sphincterotomy? Medicine Net
