An anal fissure is a small, painful tear that develops in the thin lining of the anal canal. While most acute fissures heal within a few weeks using non-surgical methods, a small percentage become chronic, persisting for more than six to twelve weeks despite consistent treatment. This chronic state results from a cycle of trauma and muscle spasm, which prevents the tear from receiving the necessary blood flow to repair itself. When conservative treatments, such as specialized creams, diet changes, and fiber supplements, fail to bring lasting relief, surgery is often recommended as the most reliable path to permanent healing.
Understanding the Surgical Procedures
The standard surgical intervention for a chronic anal fissure is the Lateral Internal Sphincterotomy (LIS). This procedure is considered the most effective treatment, offering a high success rate for healing. The non-healing nature of the fissure stems from a hypertonic internal anal sphincter muscle. This involuntary muscle is in a constant state of spasm, which reduces blood supply to the area and prevents the fissure from closing.
During an LIS, the surgeon makes a small, controlled incision into a portion of the internal sphincter muscle, typically on the lateral side away from the fissure. This partial division immediately relieves the excessive resting pressure within the anal canal. Reducing the muscle tension allows the sphincter to relax, restoring adequate blood flow to the tear site. The improved circulation and reduced spasm allow the chronic anal fissure to begin the healing process.
Sometimes, a Fissurectomy may be performed in addition to the LIS, involving the removal of scar tissue, skin tags, or hypertrophied papilla that have formed around the tear. The procedure is minor, often taking only about 30 minutes, and is frequently performed on an outpatient basis.
Pain Management During and Immediately After the Operation
The use of anesthesia eliminates the concern about feeling pain during the procedure, ensuring the patient is comfortable and unconscious or heavily sedated. The operation may be performed under general anesthesia, regional anesthesia, or local anesthesia combined with intravenous sedation, depending on the patient’s health and surgeon’s preference.
To proactively manage pain as the anesthesia wears off, the surgical team often employs pre-emptive strategies. This commonly involves injecting a long-acting local anesthetic, known as a nerve block, directly into the surgical area before the procedure concludes. This localized medication provides hours of numbness, effectively delaying the onset of acute post-operative pain and allowing a gentler transition into recovery.
The first 24 to 48 hours represent the peak of acute post-surgical discomfort, managed by a carefully planned pain regimen. This typically includes a combination of prescription-strength pain medication and non-steroidal anti-inflammatory drugs (NSAIDs). Patients should adhere to the prescribed schedule and take medication before the pain becomes severe. Stool softeners are also started immediately to prevent constipation, a major source of post-operative discomfort.
Navigating the Post-Surgical Recovery Period
While the sharp, intense pain of the original fissure often diminishes quickly after the sphincterotomy, some discomfort is expected during the initial recovery phase. Patients typically report a feeling of soreness, throbbing, or pressure around the surgical site for the first few days to a week. This discomfort is highly manageable with the oral pain medications prescribed by the surgeon. Many patients find that the post-operative discomfort is significantly less severe than the chronic pain they experienced from the fissure itself.
The most challenging aspect of recovery for many is the first few bowel movements, as the passage of stool can cause temporary stinging or pain at the wound site. To minimize this discomfort, a high-fiber diet, fiber supplements, and consistent hydration are necessary to ensure stools remain soft and bulky. Stool softeners or a mild laxative will be continued for several weeks to prevent straining, which is paramount to protecting the healing surgical site.
Soaking the anal area in a warm sitz bath for 15 to 20 minutes, three times a day and especially after every bowel movement, is strongly recommended. The warm water helps to relax the remaining muscles and increase blood flow, acting as a soothing muscle relaxant. Topical anesthetic creams, if prescribed, can be applied to the area before or after a bowel movement to numb the sensation.
The initial healing process, where the most noticeable discomfort subsides, typically occurs within the first one to two weeks, allowing most individuals to return to their normal daily routines or work. Full tissue recovery, where the surgical site completely regains its strength and function, takes a longer period, generally around four to six weeks. Maintaining the fiber, hydration, and sitz bath routine throughout this entire timeline helps ensure a smooth, lasting recovery and prevents the reoccurrence of the fissure.