Lateral internal sphincterotomy

• Drinking plenty of fluid and increasing the amount of fibre in your diet.
• Laxatives.
• Glyceryl trinitrate (GTN) and diltiazem are ointments that can be applied to the skin at your back passage. Once the treatment is stopped, symptoms will return in about 1 in 8 people. Up to 2 in 5 people have headaches with the GTN ointment.
• Botox. Infection at the injection site may happen.
• Local anaesthetic ointments.

Non-surgical treatments can be continued but they are less likely to cure the problem.

Sphincterotomy simply means dividing the sphincter.

The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible.

The operation usually takes about 15 minutes. Your surgeon will make a small cut on the skin near your back passage. They will 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.

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Improving your diet will help to speed up your recovery and will reduce the risk of the problem coming back. Drink plenty of fluid and increase the amount of fibre in your diet to avoid constipation.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• Bleeding during or after the operation. It can cause you to be bruised. Rarely, you will need a blood transfusion or another operation.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.

Specific complications of this operation

• Involuntarily passing wind or loose faeces.
• Difficulty passing urine. You may need a catheter (tube) in your bladder for 1 to 2 days.
• Permanent incontinence from your bowel.
• The problem coming back. You may need another procedure to fix it.

Consequences of this procedure

Pain is usually only mild.

You should be able to go home the same day.

The pain from the fissure should improve rapidly. You should be able to return to work after a few days, depending on your type of work.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a full recovery and can return to normal activities.

The fissure can come back, so you may need further treatment.

An anal fissure is a common condition that causes a lot of pain. At first, it may be treated with ointments, creams or Botox. If this fails, surgery is the best option for a cure.