Anal pain, especially burning and sharp pain during bowel movements, is something that many people are reluctant to talk about, but suffer a lot on the inside. Sometimes the cause is a small tear in the wall of your anal canal. We medically call this an 'Anal Fissure'. Usually, these tears heal within a few weeks with medications, ointments, and lifestyle changes. But for some people, it lasts for months, even years. That's why doctors talk about a surgery called `Lateral Internal Sphincterotomy` for someone with such a chronic tear .
Simply put, what is Lateral Internal Sphincterotomy?
Okay, while the name may sound a bit complicated, the concept is actually quite simple. A lateral internal sphincterotomy is a minor surgery performed on one of the two rings of muscle that surround your anus.
Imagine, there are two muscle rings around our anus.
1. Internal Anal Sphincter: We have no control over this. It is always tight and only relaxes during bowel movements.
2. External Anal Sphincter: We can tighten or relax this at any time.
The main reason why long-term anal fissures do not heal is the tension of this inner muscle ring . In this surgery, the surgeon makes a very small cut in the inner muscle that is too tight and reduces its tightness. It is like cutting a tight rubber band a little and loosening it. This is called `(Myotomy)`, which means cutting a muscle.
Why do you need this surgery?
You may be wondering, "Why would I need to have surgery for a small mole?" Here's the reason.
When a fissure forms in the rectum, the underlying muscle is exposed. This causes the muscle to tighten frequently and uncontrollably. We call this muscle spasm. These spasms cause two main problems:
1. Stretching the wound: When the muscle tightens, the sides of the tendon pull together. Just like when we bend our arm and have a wound on our elbow, the wound opens up. This reduces the chance of the wound healing.
2. Reduced blood flow: When a muscle is tightly contracted, the blood supply to that area is reduced. A good blood supply is essential for any wound to heal. When blood flow is reduced, the healing process stops completely.
This causes the muscle to tighten due to pain, and the muscle to tighten causes the wound to not heal and the pain to increase. It's like a vicious cycle. The `Lateral Internal Sphincterotomy` surgery breaks that vicious cycle. When the muscle tightness is reduced by between 20% and 50%, the `spasms` stop, blood flow is restored, and the wound begins to heal naturally.
Remember, not all anal fissures require surgery. However, about 40% of anal fissures do not respond to medication and can become chronic. In such cases, surgery is considered the most effective and permanent solution .
What happens before and during surgery?
This is usually not a major surgery. It is often an outpatient procedure where you can go home the same day after treatment.
Preparing for surgery
- Anesthesia: This surgery is usually performed under general anesthesia. This means that you will not feel anything during the surgery. Therefore, you will not be able to drive after the surgery. It is essential to have someone to drive you home.
- Follow instructions: Follow your doctor's instructions exactly, such as how many hours you need to fast before surgery.
During surgery
The surgery actually takes about 30 minutes. The surgeon first uses a small instrument called an anoscope to look inside the anus and find the exact location of the fissure. Then, a small incision is made on the side of the internal sphincter muscle underneath the fissure. This incision can be made with a scalpel or an electric device called electrocautery. The goal is to reduce the stiffness of the muscle to the desired level and allow the fissure to heal.
What happens after the surgery? And how is the pain?
You will feel some pain after the surgery, but many people say that this pain is much less than the sharp, unbearable pain they had before the surgery . The doctor will prescribe painkillers.
| What to expect after surgery | Description |
|---|---|
| Pain | There may be some pain that lasts for a few days. This can be controlled with painkillers prescribed by the doctor. |
| A small amount of pus or blood discharge | The wound may ooze some fluid or blood for a few days. This is normal. |
| Defecation | Constipation can occur due to anesthesia and surgery. It may take a day or two for the first bowel movement. |
| Rest | It is important to rest for a week or two. Avoid heavy lifting and strenuous work. |
How to make defecation easier?
You may feel some pain when you have a bowel movement after surgery. But this is nothing new to you. There are a few things you can do to help with this:
- Stool softeners: Use stool softeners (as directed by your doctor).
- Water and fiber-rich foods: Drink plenty of water. Eat more fiber-rich foods like fruits, vegetables, and whole grains.
- Sitz bath: Sit in a basin of lukewarm water for 10-15 minutes. This will reduce pain and help keep the wound clean.
- Baby wipes: Using baby wipes instead of toilet paper can reduce damage to the wound.
What are the benefits and possible risks of this surgery?
Like any surgery, this one has benefits and very minor risks.
The main advantage is that you can permanently get rid of the pain that has been bothering you for a long time, with a success rate of about 95% . This will greatly improve your quality of life.
Risks (Complications):
These are very rarely seen things.
- Minor fecal incontinence: As the muscles relax, you may experience a small amount of stool or air leakage during the healing process. This is temporary for most people and will go away completely within a few weeks.
- Urinary retention: Some people may experience some difficulty urinating after surgery. This usually resolves on its own.
- Infection or bleeding: As with any surgery, there is a very small risk of infection.
- Recurrence of the rash: Very rarely, the rash may recur.
Your doctor will talk to you about these risks and help you make the decision that is best for you.
When to see a doctor
If you experience any of the following symptoms after surgery, notify your doctor immediately:
- Signs of infection such as fever, swelling, and redness of the wound .
- Excessive bleeding or foul-smelling pus.
- Severe pain that cannot be controlled even with painkillers.
- Inability to urinate.
Are there other alternative treatments?
Yes, there are other options. `Fissurectomy` is another surgical procedure. In this, the fissure and surrounding tissue are removed without cutting the muscle. At the same time, `Botox` is injected to relax the muscle. However, `Lateral Internal Sphincterotomy` is considered the `gold standard` and has been used for a long time with the highest success rate.
For someone who has been suffering from anal fissures for months, the thought of surgery can be scary. But it can actually bring you the relief you need. You will start to feel a big difference within a few days after the surgery.
Take-Home Message
- If an anal fissure persists for more than two months without healing with medication, it is considered a chronic condition.
- `Lateral Internal Sphincterotomy` is a highly successful (95%) and simple surgery that reduces the tightness of the muscles inside the rectum, allowing the fissure to heal.
- The pain after surgery is usually much less than the pain from the incision.
- Although it takes about 6 weeks to fully heal, you will start to feel great relief within a few days.
- If you have any concerns or fears about the surgery, discuss them openly with your doctor. They will provide you with the best solution.
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