Lateral internal sphincterotomy to heal anal fissures
Surgery may be necessary if medication fails to heal a tear (fissure) in the anus. The preferred procedure is lateral internal sphincterotomy. A doctor makes a small incision in the internal anal sphincter, one of two muscles that control the anus. This can be done as outpatient surgery under local or general anesthetic.
The internal anal sphincter is always under tension, also known as resting pressure. If that pressure becomes too high, a fissure may form or an existing one may not heal. The incision reduces the resting pressure, allowing the fissure to heal.
Several studies have proved the effectiveness of this treatment. One study found that surgery worked better than nitroglycerin ointment to heal fissures.1
The major drawback is the potential loss of control (incontinence) of gas. Stool (fecal) incontinence is uncommon, but it does happen. Studies report varying risks of incontinence. After surgery, some people may have pain, bleeding, or temporary inability to control gas; about 8% of people have long-term complications.2 If you are deciding whether to have this surgery, it is important that you consider the chance of incontinence.
| Author: | Ralph Poore | Last Updated: June 16, 2006 |
| Medical Review: | Kathleen Romito, MD - Family Medicine C. Dale Mercer, MD, FRCSC, FACS - General Surgery | |
 | ||
| |