An anal fissure is a small tear in the delicate lining of the anus. This tear can cause significant pain and bleeding, especially during bowel movements. When non-surgical approaches are insufficient to heal this condition, a fissurectomy may be considered to remove the anal fissure.
Understanding Anal Fissures and Fissurectomy
Anal fissures often develop from trauma to the anal lining. Common causes include passing hard or large stools, straining during bowel movements, prolonged diarrhea, or childbirth. These tears typically result in symptoms such as sharp pain during and after bowel movements, which can last for several hours, and bright red blood visible on the stool or toilet paper. The pain can also lead to spasms in the internal anal sphincter muscle, which can reduce blood flow to the area and hinder healing.
A fissurectomy removes the anal fissure itself. This typically involves excising the torn tissue along with any associated scar tissue, skin tags (sentinel piles), or hypertrophied papillae (enlarged tissue) that might be preventing the fissure from healing. It is often performed in conjunction with a lateral internal sphincterotomy, a procedure that involves making a small incision in the internal anal sphincter muscle to reduce muscle spasm and improve blood flow, thereby promoting healing.
When Fissurectomy is Considered
Fissurectomy is generally considered for chronic anal fissures that have not responded to conservative treatments. These non-surgical methods, which aim to soften stools and reduce anal pressure, include dietary changes to increase fiber intake, the use of stool softeners, and topical medications. A fissure is often deemed chronic if it persists for six to eight weeks or longer despite these efforts.
The procedure may also be recommended when the fissure is complicated by other anatomical issues, such as large sentinel piles (skin tags formed at the external edge of the fissure) or hypertrophied papillae (enlarged tissue inside the anal canal). In some instances, severe, persistent pain, bleeding, or the development of an infection like an anal abscess may also lead to considering surgical intervention.
The Fissurectomy Procedure
A fissurectomy is typically performed under general anesthesia, ensuring the patient is asleep and comfortable throughout the surgery. The patient is positioned to allow the surgeon clear access to the anal area, such as the lithotomy or prone jackknife position. The surgical site is prepared with an antiseptic solution before the procedure begins.
During the procedure, the surgeon carefully excises the anal fissure and any surrounding diseased tissue, including scar tissue, skin tags, or hypertrophied papillae. The goal is to remove the non-healing tissue to create a fresh wound that can heal properly. Often, a lateral internal sphincterotomy is performed concurrently, which helps to relax the muscle, reduce spasm, and improve blood flow to the area, important for healing the fissure.
After the excision and any complementary procedures, the surgical site may be left open to heal naturally, or it might be partially closed with sutures, depending on the surgeon’s preference and the specific characteristics of the wound. The procedure is typically outpatient, allowing most patients to return home the same day.
Post-Operative Recovery and Care
Following a fissurectomy, patients can expect some pain and discomfort in the anal area, which is managed with prescribed pain medication. Preventing constipation and straining during bowel movements is crucial, as this can impede healing and cause pain. Most individuals can resume their regular daily activities within a few days to a week, though complete healing of the surgical wound can take several weeks, typically ranging from 6 to 10 weeks.
Regular sitz baths (sitting in warm water for 15-20 minutes multiple times daily, especially after bowel movements) are recommended to soothe the area, reduce swelling, and promote cleanliness. A high-fiber diet and adequate hydration are important to maintain soft stools, and stool softeners may also be prescribed.
Patients should avoid straining during bowel movements and gently clean the area with damp cotton or water instead of dry toilet paper. It is normal to experience some light bleeding or discharge for several days or weeks after the surgery. However, if there is excessive bleeding, persistent or worsening pain, fever (above 101 degrees Fahrenheit), or signs of infection such as pus, contacting a healthcare provider promptly is necessary.