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Anal fissure surgery Q&As

Published by Bupa's health information team, August 2008.

Answers to questions about anal fissure surgery

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

Will I feel any pain when I open my bowels after the operation?

Yes, you will feel sore for at least a week after the operation.

Explanation

The fissure is still present after surgery. The cut in the sphincter muscle stops the muscle from going into spasm and it means you will need to strain less when you go to the toilet, allowing time for the fissure to heal.

The area will feel sore, especially when you go to the toilet and you will need to remove the wound dressing beforehand. Carefully wash and dry the area after having a bowel movement. You may find it useful to have a bath.

You should eat a healthy diet rich in fibre, fruit and vegetables and drink plenty of fluids to prevent constipation. Mild laxatives can also help minimise any discomfort during bowel movement.

Further information

Sources

  • Nelson RL. Treatment of anal fissure. BMJ 2003; 327:354-355
  • Collin EE, Lund JN. A review of chronic anal fissure management. Tech Coloproctol 2007; 11:209-223
  • Ayantunde AA, Debrah SA. Current concepts in anal fissures. World J Surg 2006; 30:2246-2260
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What are my options if the anal fissure doesn't heal after surgery?

Your doctor may suggest alternative operations such as fissurectomy or anal advancement flap if the anal sphincterotomy fails to heal the fissure.

Explanation

Anal sphincterotomy has the best healing rate and is the most widely used procedure for anal fissures. If the fissure fails to heal after a sphincterotomy or it re-occurs your doctor may suggest having a fissurectomy or advancement flap.

Fissurectomy

Fissurectomy involves removing the anal fissure completely. It can be used alone or with sphincterotomy or medicines such as glyceryl trinitrate or botulinum A toxin injections. Fissurectomy is often used for treatment of fissure in children to avoid permanent damage to the internal sphincter muscles (the ring-like band of muscle that opens or closes the anus).

Advancement flaps

The advancement flap is a technique that involves replacing the broken tissue in the fissure with healthy tissue. This type of procedure is recommended if you are at risk of being unable to control your gas and bowel movements (faecal incontinence).

Further information

Sources

  • Nelson RL. Treatment of anal fissure. BMJ 2003; 327:354-355
  • Collin EE, Lund JN. A review of chronic anal fissure management. Tech Coloproctol 2007; 11:209-223
  • Ayantunde AA, Debrah SA. Current concepts in anal fissures. World J Surg 2006; 30:2246-2260
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What increases my risk of having an anal fissure?

The most common cause of an anal fissure is constipation.

Explanation

An anal fissure is a small tear in the skin around the opening of your anus. Straining too hard during bowel movement can cause the skin to tear. A diet rich in fibre, fruit and vegetables and drinking plenty of water or fruit juice can help prevent constipation.

Other risk factors for anal fissures include:

  • Crohn's disease
  • human immunodeficiency virus (HIV) infection
  • diabetes
  • recurrent or chronic diarrhoea
  • anal sexual intercourse or sexual abuse

You must speak to your doctor if any of these risks apply to you. Your doctor will discuss with you how to best manage your circumstances and reduce your risk of having an anal fissure.

Further information

Sources

  • Ayantunde AA, Debrah SA. Current concepts in anal fissures. World J Surg 2006; 30:2246-2260
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Is there any reason why anal sphincterotomy shouldn't be performed in women?

There is a significant concern about performing anal sphincterotomy in women who are at risk of being unable to control their bowel movements (faecal incontinence), particularly after a forceps delivery.

Explanation

Women who suffer trauma during childbirth are particularly at risk of developing problems with bowel control. The advancement flap technique is better suited and offers considerable advantages for women of childbearing age. This procedure involves replacing the broken tissue in the fissure with healthy tissue.

Sources

  • Nelson RL. Treatment of anal fissure. BMJ 2003; 327:354-355
  • Collin EE, Lund JN. A review of chronic anal fissure management. Tech Coloproctol 2007; 11:209-223
  • Ayantunde AA, Debrah SA. Current concepts in anal fissures. World J Surg 2006; 30:2246-2260
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Does nicorandil cause anal fissures?

Yes, current evidence suggests nicorandil may increase your risk of having anal fissures.

Explanation

Nicorandil is used to control angina (chest pain). Angina occurs when the heart muscles don't receive enough oxygen. Nicorandil works by relaxing blood vessels and increasing the supply of blood and oxygen to the heart, while reducing its workload.

Studies have shown that nicorandil causes mouth ulcers. Some have suggested nicorandil may cause ulceration or bleeding in the stomach or intestines, including anal ulceration. These types of ulcers are very rare, but they usually only get better if treatment with nicorandil is stopped.

For this reason, if you are prescribed nicorandil it is important that you consult your doctor immediately if you experience any sign of ulceration or bleeding from the stomach or intestine. Signs to look out for include:

  • bleeding from the back passage
  • pain, irritation or itching in the back passage
  • vomiting blood, or passing black, bloodstained faeces
  • ulcers in your mouth or back passage

You should never stop taking nicorandil without consulting your doctor. If it is decided that you should stop treatment with this medicine it should only be done under the supervision of your doctor.

It's possible that nicorandil may increase your risk of having anal fissures, especially if you have had them in the past. It's best to discuss your risk with your doctor before starting nicorandil treatment.

Sources

  • Watson A, Ozairi OA, Fraser A, Loudon M, O'Kelly T. Nicorandil associated anal ulceration. The Lancet 2002; 360:546
  • Ikorel (nicorandil). NetDoctor. www.netdoctor.co.uk, accessed 21 August 2008
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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2008

 

 

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