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Anal fissure surgery

This section contains answers to frequently asked 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?

Answer

Yes, you may feel sore for a few days, or longer, after the operation.

Explanation

After having anal fissure surgery, your anus will feel sore, especially when you go to the toilet. If you need pain relief, you can take over-the-counter painkillers such as paracetamol and ibuprofen. You shouldn’t take any medicines that contain codeine because they can cause constipation. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You will need to carefully wash and dry the area after having a bowel movement to reduce your risk of infection. You may find it helpful to have a bath.

You should eat a healthy diet rich in fibre, fruit and vegetables and drink plenty of fluids to prevent constipation. Your doctor may prescribe laxatives to make your faeces softer and easier to pass.

What are my options if the anal fissure doesn't heal after having a lateral internal sphincterotomy?

Answer

Your surgeon may suggest having another operation using an alternative technique, such as a fissurectomy or anal advancement flap.

Explanation

A lateral internal sphincterotomy has the best healing rate and is the most widely used procedure for anal fissures. However, if the fissure fails to heal or reoccurs your surgeon may suggest repeating the operation or using an alternative technique to help the fissure heal. There are two alternative options.

  • Fissurectomy – the fissure is surgically removed and the wound is left to heal naturally.
  • Advancement flaps – the broken tissue in the fissure is replaced with healthy tissue.

Ask your surgeon for information about alternative treatment options.

Is there any reason why anal sphincterotomy shouldn't be performed in women?

Answer

Anal sphincterotomy isn’t recommended as the treatment of choice for women of childbearing age because it may increase the risk of being unable to control bowel movements.

Explanation

Women who suffer trauma during childbirth are particularly at risk of developing problems with bowel control. A potential complication of anal sphincterotomy includes damage to your anal sphincter muscle, which can lead to problems with bowel control. For this reason, anal sphincterotomy isn’t recommended as the treatment of choice for women of childbearing age.

The advancement flap technique is a better option and offers considerable advantages for women of childbearing age. This procedure involves replacing the broken tissue in the fissure with healthy tissue. The operation may involve using a tissue graft taken from another part of your body or using nearby skin or tissue flaps.

What increases my risk of having an anal fissure?

Answer

The most common cause of an anal fissure is constipation.

Explanation

An anal fissure is a small tear or ulcer (open sore) in the skin around the opening of your anus. Straining too hard during bowel movement can cause the skin to tear. Having a diet rich in fibre, fruit and vegetables and drinking enough fluids can help prevent constipation.

Other risk factors for anal fissures include:

  • inflammatory bowel disease, such as Crohn's disease
  • HIV infection
  • recurrent or chronic diarrhoea
  • sexually transmitted infections
  • certain medicines (eg nicorandil)

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

Does nicorandil cause anal fissures?

Answer

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

Explanation

Nicorandil is a medicine used to control angina (chest pain). Angina occurs when your 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 your 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're prescribed nicorandil it's important that you consult your doctor immediately if you have any sign of ulceration or bleeding from your stomach or intestine. Signs to look out for include:

  • bleeding from your back passage (rectum)
  • pain, irritation or itching in your rectum
  • vomiting blood, or passing black, blood-stained faeces
  • ulcers in your mouth or rectum

You should never stop taking nicorandil without consulting your doctor. If it's decided that you should stop treatment with this medicine, this will be done under the supervision of your doctor. If you have had anal fissures in the past, you should let your doctor know prior to starting treatment with nicorandil, so alternatives can be considered.

 

Produced by Krysta Munford, Bupa Health Information Team, December 2012.

For our main content on this topic, see Information.

For sources and links to further information, see Resources.

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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 reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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