Non-Healing Anal Fissures: Medications & Sphincterotomy

Medically reviewed by: Gary H. Hoffman, MD

Anal Pain.  When Medication Fails.  Sphincterotomy.

One of the most painful conditions affecting the anal opening is the dreaded anal fissure.  A small tear in the lining of the anus, it produces pain and bleeding out of proportion to its size.  Few other conditions take up as much time for the proctologist (also known as a colon and rectal surgeon), as the fissure.  Many in Los Angeles struggle with an acute or chronic anal fissure.

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With the constant opening and closing of the anus, it is surprising that is not even more common.  Who develops an anal fissure?  Although the answer is somewhat an unknown, certain traits are more common in those who do develop a fissure.

Anal Care.

There are ways to care for your anal opening, and there are also things that you can do that will place stress on the anal tissues.

The  6 Common harmful things affecting the anal opening:

  • Soap use.  To clean the anus with soap is akin to using soap in your eye.  You can clean with baby wipes or water.  No soap!
  • Vigorous anal wiping after a bowel movement.
  • Prolonged sitting on the toilet.  This speaks for itself.
  • Using excessive pressure to force a hard bowel movement.
  • Carelessly and roughly inserting various items into the anus.
  • Allowing diarrhea to become explosive, thus acutely dilating the anal opening.

What To Do when You Have A Fissure.

A trip to the proctologist, also known as a colon and rectal surgeon, is probably the first agenda item, with the onset of painful rectal bleeding.  Your proctologist will talk with you and gently examine you.  The diagnosis of an anal fissure is usually straightforward.  Medications can then be prescribed. One or more of the following may be used:

  • Hydrocortisone ointment placed topically.
  • Hydrocortisone suppositories used twice daily.
  • A calcium channel blocker such as Diltiazim 2%® to relax the anal smooth muscle
  • Nitroglycerin 0.2 % to relax the anal smooth muscle.
  • Injectable Botox® to temporarily paralyze the anal sphincter, thus decreasing the resting muscular pressure, allowing the fissure to heal.
  • A stool softener.

The Operating Room.

When medications do not facilitate healing, and when the pain or bleeding become overwhelming, your proctologist may recommend a lateral internal sphincterotomy, or sphincterotomy for short.  This is a procedure performed under intravenous anesthesia, as an outpatient at a surgical center or hospital such as Cedars-SinaiMedicalCenter in Los Angeles.

The anal sphincter has an internal and external components.  The surgeon will cut a small amount of internal sphincter allowing the area to relax, facilitating the ingrowth of new blood vessels and increasing tissue oxygenation.  This usually heals the fissure.  Most patients report relief of pain soon after the sphincterotomy.  Many patients have read about incontinence (difficulty controlling flatus or gas, or stool), following a sphincterotomy.   Fortunately, incontinence is not common.  Common after the operation are postoperative, temporary incisional pain at the site of the sphincterotomy, minor bleeding and…relief.

In trained hands, the operation is safe and efficient, and has a high success rate.  At Los Angeles Colon and Rectal Surgical Associates,  board certified surgeons will help you during the pre-, intra- and postoperative periods.  They will patiently answer your questions and discuss all aspects of your care.  You can make an appointment by calling (310)273-2310.  There is also pre-appointment literature online at the office websites.

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