Sphincterotomy

A sphincterotomy is a surgery used to treat anal fissures. There are sphincter muscles all throughout the digestive system. These muscles are like doors for certain areas of your body. They close to prevent things from leaking, and they open to allow things to flow through. Sphincter muscles are in the stomach, anus, and bladder. A sphincterotomy treats the sphincter muscle in the anus. The anus contains both an internal and external sphincter muscle. Anal fissures are tears in the anal cavity. When you have a fissure, you experience symptoms of burning, blood in the stool, and itching. When medicine fails to work, a sphincterotomy may be the only option.

Cause

An anal fissure is a tear in the anal cavity. Anal fissures usually occur because of trauma. The most common source of anal fissures is the passage of hard and large stool. The stool may rip the inside of the anal cavity causing a lot of pain and discomfort. You will notice blood in the stool and may even have itching in that area. Normally, anal fissures heal on their own. When they do not, the doctor will prescribe ointments or steroids. If these treatments don’t work, surgery may be your next option. The best method of surgery for this problem is a sphincterotomy.

Sphincterotomies are done to treat anal fissures when nothing else works. The surgery is called a lateral internal sphincterotomy. In most cases, the surgery is not done to the external sphincter muscle but the internal sphincter muscle. The internal sphincter is usually the problem because it is under more pressure than the external sphincter. That pressure increases when you have a tear. Sometimes the tear is unable to heal because the pressure put on the sphincter. You would think the surgery closes the tear, but the surgery does nothing to the fissure. The operation is strictly on the sphincter muscle.

Techniques

The surgery requires either local or general anesthesia but is outpatient. There are two techniques used in surgery: open technique or closed technique. Both techniques involve cutting through the internal sphincter muscle. The difference in procedure is based on the location of the cut. The anoderm is important to understand when talking about the sphincterotomy. The anoderm is the outer lining of the anal canal. This is the area that fissures occur. The surgery requires cutting under the lining or through the lining. The open technique involves cutting through the anoderm. The doctor may use scissors to make this cut. The closed technique involves cutting under the anoderm. This technique requires the use of a scalpel. Only one cut is made in part of the anal cavity. The surgery does not require cutting through the whole anal cavity. The doctor stays away from the fissure because they do not want to make the fissure deeper or weaken the muscle. The point of cutting the sphincter muscle is to relieve the pressure that is keeping the fissure from healing. It makes the muscle relax which assists in the healing process. Although it is not popular to cut out the fissure, it may be necessary when there are other factors involved like cancer and hemorrhoids.

Complications

Some complications of surgery include fecal incontinence, hemorrhaging, and anal stenosis. Sometimes the muscles become weakened making it difficult to hold stool. You may even pass gas a lot. With any surgery, there is a risk of bleeding and infection. Anal stenosis is the narrowing of the anal cavity due to inflammation or scar tissue. In this case, the scar tissue may increase to the point that you have trouble passing stool.

Sphincterotomy md top10mdAfter surgery, the pain associated with the procedure is minimal. It lasts only a few days. There will also be some pain with bowel movements, but that too will be temporary. After a few weeks, you should be able to return to your normal activities. A complete recovery may take up to a month and a half. While you are recovering, you should continue doing physical activity, but only do what you can. If you are a runner, you should start out by walking just to get your body adjusted to the moving again. Your diet is very important. The worst thing you can do is get constipated. You need to eat a high fiber diet to make sure you are regular. Eating a diet high in fat and dairy will make the stool hard and may even cause another fissure. Taking a nice soothing bath also helps with the healing process.

Sphincterotomies are not the most common surgery, but if you have a fissure that will not heal, you may have to undergo this procedure. The good thing about this procedure is that nearly 95% of people who have it experience fissure healing. There are risks and possible complications with the procedure, but the benefits outweigh those risks. No one wants to experience consistent pain when using the restroom. If you are suffering from a fissure, talk with your doctor about a sphincterotomy. It could be the best treatment for you.

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