Anal fissure surgery is usually the last treatment option recommended to patients with an anal fissure. If medication and home remedies fail to treat this disease, the next option is conventional surgery or laser surgery. An anal fissure is a small tear in the thin, moist tissue that lines the anus. The main cause of this condition is constipation. In fact, intense bowel movements cause severe pain and irritation. An anal fissure can be treated by simple methods such as changing the diet and taking a warm water bath. Otherwise, medical solutions and fissure surgery are employed to treat this disease.
Best time for anal fissure surgery
Undoubtedly, the first option for treating an anal fissure is not a surgical procedure. In other words, surgery is employed in the advanced stages of the disease or when other treatments fail to improve the condition. Consumption of fiber supplements, drinking plenty of water, administration of nitroglycerin ointments under a physician’s prescription, etc. all can reduce the sphincter’s spasms, facilitate bowel movements, and, thereby, reduce pain. An anal fissure remains in the acute phase for a month and a half and then enters the chronic phase. Since a chronic anal fissure does not respond to medication, there is no other option but to prepare for fissure surgery.
When all existing medical treatments fail to improve an anal fissure, the patient should undergo fissure surgery. Lateral internal sphincterotomy is the best method for fissure surgery. During this procedure, the inner layers of the sphincter are divided in order to reduce muscle pain and spasm. In case of large anal fissures or when this procedure cannot produce positive results, the surgeon may make incisions on adjacent tissues to find a way for repairing the damaged tissue. Fissure surgery is recommended to be done with a high-power laser to minimize the damage to the anal tissue. In addition, fissure laser surgery requires a very short recovery period and minimizes the risk of recurrence (almost zero).
Preparations for anal fissure surgery
Depending on the patient’s medical conditions, the surgeon may prescribe the patient to discontinue some medications before anal fissure surgery. These medications may include blood thinners, such as aspirin, and dietary supplements, such as vitamin E.
The surgeon usually asks the patient to avoid eating heavy and fatty meals and keep the intestines relatively empty from two days before surgery. The patient should have a light meal the night before anal fissure surgery. In addition, the patient may be prescribed to use a bisacodyl suppository to empty and clean the intestines one day before surgery.
If the patient consumes more high-fiber foods, he/she will have easier bowel movements and experience less pain during defecation. These items help the patient to control constipation and facilitate the healing process. In addition, increasing fiber in the diet can lead to bulky stool.
Post-fissure surgery recovery
The postoperative recovery period may differ from patient to patient depending on the severity of the disease and surgery method. You can resume your activities shortly after fissure surgery. However, you should avoid sitting or walking for a long time. In addition, it is better to use a soft pillow or a medical ring for sitting on a surface.
You should not drive until your general surgeon permits you because driving for a long time after fissure surgery can put extra pressure on the anus and cause serious damage. The surgeon may prescribe you painkillers and anti-inflammatory drugs based on your condition. Since you may feel severe pain with any bowel movement and during defecation, take painkillers such as ibuprofen to reduce the severity of pain.
Do not use opioids or narcotics at all to relieve your pain because they can cause constipation. Therefore, it is recommended to consult your surgeon before taking any food or medicine in order to prevent problems such as constipation and the recurrence of the disease.
Practicing good personal hygiene after anal fissure surgery
One of the most important issues that should consider after anal fissure surgery is to practice good personal hygiene and keep the anal area clean. Sitting in a basin of warm water three times a day can greatly reduce pain and facilitate the healing process. You can immediately notice the soothing and healing properties of warm water after fissure surgery. It is also recommended to wear loose clothes made of cotton because tight and plastic clothes can cause irritation and allergies.
A video of anal fissure surgery
Frequently asked questions (FAQs) about anal fissure surgery:
1-Is it possible to perform hemorrhoid surgery and anal surgery in a single session?
Since the conventional surgery of anal fissures causes severe inflammation and bleeding, it is not possible to manipulate a large area of the anus during this procedure. However, an experienced general surgeon and laser surgery specialist can perform both hemorrhoid surgery and fissure surgery using laser equipment in a single session. In fact, laser equipment allows surgeons to treat different anorectal diseases simultaneously.
2-How one may experience anal fissure surgery?
The surgeon will prescribe you laxatives or suppositories to empty the intestines in a way that you do not need to defecate for 24 hours after the operation. You will feel no pain during surgery because it is performed under anesthesia and you should take painkillers after surgery to reduce pain and inflammation. Fissure laser surgery requires a very short recovery period. Depending on the surgery method, it may take 2 to 20 days for you to be able to return to your workplace. You should sit in a basin of warm water several times a day and do postoperative care as prescribed by your surgeon.
3-Is it normal to feel irritation after anal fissure surgery?
Conventional fissure surgery, especially using a cauter, causes irritation for a few days. By contrast, patients do not feel irritation after fissure laser surgery because the laser repairs the affected tissue at the same time.
4-What is the best diet after anal fissure surgery?
The best meal within the first 24 hours after fissure surgery is watery and hearty foods such as light soups made of meat and chicken extract. To prevent constipation after fissure surgery, it is recommended to add more high-fiber foods, vegetables, and juices to your diet. In addition, drinking 8 glasses of water and enough physical activity can help you prevent constipation and recurrence of the anal fissure. It is also recommended to replace rice with boiled potato and avoid foods that can cause constipation, such as fast foods.
5-Is it necessary to administer a fissure ointment after fissure surgery?
There is no need for the administration of an ointment if you undergo fissure laser surgery and have no special problem. The surgeon may only prescribe you a laxative syrup or a high-fiber diet to prevent constipation.
6-Is fissure surgery a painful procedure?
You will definitely feel no pain during fissure surgery because it is performed under general or spinal anesthesia. The postoperative pain is not as severe as the disease pain and can be easily relieved with simple painkillers. However, if you experience constipation or the surgical site gets infected, you will feel abnormal pain. In such cases, be sure to contact your surgeon.
7-How one may experience fissure laser surgery?
Preparations for fissure laser surgery are similar to those for conventional surgery, but patients can go home after laser surgery and resume their daily routines the next day. If you have a child or your job requires intense physical activity, you are recommended to rest at home for three days and avoid doing physical activities or lifting your child and heavy objects.