When Do Anal Fissures Require Surgery?

Your once unremarkable trips to the bathroom have now become sources of dread thanks to an anal fissure that’s making bowel movements downright painful. And sometimes the pain lasts long after you’ve had a bowel movement.

It might surprise you to know that you’re hardly alone in your discomfort, as there’s nearly an 8% lifetime risk for anal fissures. In the United States, between 240,000 and 342,000 cases of anal fissures are diagnosed each year.

As board-certified colorectal surgeons, the team at Fairfax Colon & Rectal Surgery certainly has its fair share of experience with anal fissures, and our goal is likely the same as yours — relief.

With that in mind, we dive into how we treat anal fissures and when an in-office procedure is the best step toward putting an end to the problem.

Anal fissures at a glance

As the name suggests, an anal fissure is a tear or opening in the lining of your anal canal. There are several reasons why people develop anal fissures, including chronic constipation, childbirth, and direct trauma to the anal canal.

This tear can cause no small amount of pain, especially when you’re having a bowel movement, and this pain can also persist afterward, sometimes for hours, thanks to muscle spasms in your sphincters.

Treating anal fissures conservatively

We always recommend trying conservative efforts to start when it comes to anal fissures, which often include:

• A higher fiber diet to keep your stool moving
• Topical lidocaine creams for pain relief
• Nitroglycerin ointment to relax your anal sphincter and increase blood flow
• Laxatives
• Sitzbaths

It may take some time, but in many cases, these efforts and a bit of patience are enough to allow the fissure to heal.

When an anal fissure persists

The healing environment inside your anal canal is a tricky one since the area is active and sensitive. A good comparison is an injury inside your mouth or throat — you have to eat, so you can’t avoid the area, which can get in the way of healing.

Well, the same thing is happening in your anus, which is why some people develop chronic anal fissures — fissures that last 8 weeks or more. In such cases, we employ a procedure known as a lateral internal sphincterectomy, which we perform routinely at our practice.

While we use the term surgery in the title, and technically this is correct, a lateral internal sphincterectomy is an in-office procedure that takes us about 30 minutes to perform, and we only need to use local anesthesia or sedation. Better still, you’re free to go home afterward.

During a lateral internal sphincterotomy, we separate the internal sphincter muscles from the external sphincter muscles to relieve the pressure inside your anus. This is important because, as we already mentioned, the pain you feel after having a bowel movement is often due to muscle spasms in your sphincters. These spasms can block blood flow and disrupt the healing process.

So, when we separate your sphincter muscles, there’s less tension in your anal canal and more blood flow, which encourages healing. In fact, this procedure boasts an impressive 90% success rate.

There’s some healing time involved, and you might feel sore for a few days afterward, but most anal fissures heal completely after 6 weeks.

So, if you’re struggling with an anal fissure that’s not getting better with conservative treatments, it might be time to sit down with one of our experts to learn more about the lateral internal sphincterectomy procedure. To get the ball rolling, simply contact our office in Fairfax, Virginia, at 703-280-2841 to schedule a consultation.