Anal fissure procedures
Your health expert: Mrs Sara Badvie, Consultant Laparoscopic, Colorectal and General Surgeon
Content editor review by Sarah Smith, February 2021
Next review due February 2024
An anal fissure is a small tear or split in the skin around the opening of your bottom (anus). If you have an anal fissure and it hasn’t healed with self-help measures and medical treatments, your doctor may suggest a procedure to treat it. There are several different types of procedure available. Your doctor will discuss the options with you.
About treatments for anal fissure
Anal fissures are relatively common and they often affect adults from mid-teens to the age of 40. They can cause severe pain while you’re going to the toilet and sometimes for up to a couple of hours afterwards. They can also cause bleeding.
Fissures are thought to develop when the sphincter muscles that control when you poo, spasm and tense up. This reduces the blood supply to the area, which stops the tear from healing properly. Sometimes anal fissures can be caused by constipation.
Anal fissures often heal within 6 to 8 weeks using self-help measures. These include eating high fibre foods, drinking more, and taking medicines to soften your poo. Taking over-the-counter painkillers and warm baths can help to ease symptoms too. Your doctor may also prescribe you an ointment or cream.
If these measures don’t help and the fissure doesn’t heal, your doctor may suggest other treatments. The main procedures are covered in the sections below.
Botulinum toxin injections
What are botulinum toxin injections (Botox) for anal fissure?
Botulinum toxin (Botox) is a medicine usually used to treat conditions that cause muscle spasm. It can be injected into the sphincter muscle in your bottom, which helps it to relax. That in turn helps the fissure to heal naturally. You’re likely to be offered a Botox injection before you’re offered another procedure. Talk to your doctor about your options.
Botox is given as an injection. You’ll have the procedure in a hospital operating theatre, under general or local anaesthesia. Most people will have the procedure under a general anaesthetic. This means you’ll be asleep for the procedure.
How well does it work?
The evidence about how well Botox works is mixed. But some research studies show that the fissure heals in as many as six or seven in every 10 people who are given Botox. You might need a second set of injections three to four months after the first one for the fissure to heal completely. It’s possible to get a fissure again after Botox injections, sometimes years later.
What are the risks?
There can be side-effects of Botox injections. You may have problems controlling your bowels, including when you poo or when you pass wind. This is usually temporary.
Very rarely, Botox can spread to other parts of your body, causing weakness in your muscles and difficulties with breathing. Talk to the healthcare team at the hospital if you experience any of these symptoms after the procedure.
Fissurectomy
Your surgeon may suggest having a procedure called a fissurectomy alongside Botox injections. This involves cutting away the damaged skin from around the anal fissure.
Lateral internal sphincterotomy
What is a sphincterotomy?
This procedure involves cutting the sphincter muscles in your bottom to release the tension, which lets the fissure heal. Your doctor will usually only suggest this after you’ve tried other treatments first, including Botox. You’ll usually have the operation under general anaesthesia, which means you’ll be asleep during it.
The procedure can be done in two ways. In an open sphincterotomy, your surgeon makes a small cut in your skin so they can see the sphincter muscle. The cut is usually left open to heal. In a closed sphincterotomy, your surgeon passes a blade under your skin to reach and cut the muscle.
How well does it work?
Lateral internal sphincterotomy is the most effective type of surgery for anal fissure. Between nine and 10 people out of every 10 who have this surgery find that their fissure heals.
What are the risks?
The main complication after this type of surgery is incontinence. Around three in 10 people may have some problems controlling their bowels, including when they poo or pass wind. These problems usually get better over time, but for a small number of people they can be permanent.
Other possible complications include the following.
- An infection which causes an abscess. If this happens it’s usually treated by draining the abscess or taking antibiotics.
- An anal fistula. This is a small channel that develops between the inside of your bottom and your skin. It can usually be treated with a small operation.
Anal advancement flaps
In this procedure, your surgeon takes a piece of healthy skin and stitches it in place to replace the damaged skin in the fissure. It’s not as effective a treatment as lateral internal sphincterotomy but it’s less likely to cause incontinence. Your surgeon may suggest it if you’re more likely to develop incontinence after surgery.
Deciding on treatment
Your doctor will talk to you about your treatment options and make sure you understand what’s involved. If they’re recommending a certain procedure, they will discuss what will happen before, during and afterwards, and any possible complications you might have.
This is your chance to ask questions so that you understand what will happen. You can go away and think about your options – you don’t have to go ahead with a procedure if you decide you don’t want it. You might decide to carry on trying other treatments.
If you do decide to go ahead with a procedure, you’ll be asked to sign a consent form (sometimes called an agreement form).
What to expect after an anal fissure procedure
Anal fissure procedures are usually done as a day-case procedure in a hospital. This means you have the procedure and go home on the same day.
You’ll need to rest until the effects of the anaesthetic have worn off. You may also need pain relief to help ease any discomfort. You should be able to go home as soon as you feel ready. Make sure someone can take you home.
A general anaesthetic can affect your co-ordination and make it difficult to think clearly. As well as not driving, you shouldn’t drink alcohol, operate machinery or sign anything important. You should ask someone to stay with you for a day or so while the anaesthetic wears off.
Your nurse will give you some advice about caring for your healing wounds before you go home. They will also tell you when you can have a bath. You might bleed a little bit when you do.
You may also be given a date for a follow-up appointment to check that your wound and fissure are healing properly.
Recovering from anal fissure procedures
You may be given painkillers and medicines to soften your poo and prevent constipation. You should also drink plenty of fluids and eat foods that have a lot of fibre in them to help stop the anal fissure coming back. High-fibre foods include fruit and vegetables, wholegrain breads and cereals.
It’s important to keep your bottom clean and dry. In the first few days after surgery, have a bath or shower after every bowel movement (poo). Then clean the area with damp cotton wool. You might notice blood in your poo or on the toilet paper for up to 10 days after your operation. Some people also get mucous discharge in their poo for a few days.
The recovery time varies from person to person, although most people feel well enough to return to their usual activities within a few days.
If you have severe pain, bleeding or a fever, you should get medical advice. The hospital might give you a specific number to call.
Yes, probably. You should expect some pain and discomfort in your bottom (anus) after anal fissure surgery. The pain is usually worst during the first seven days after the operation and should get much better after this first week.
It’s going to be more comfortable for you to poo if your poo is soft. You can help soften your poo by drinking plenty of fluids and eating foods that have fibre in them, such as fruit and vegetables and wholegrain foods. Make sure you take any laxative that your surgeon has prescribed too.
If the fissure doesn’t heal, or it comes back after a sphincterotomy, your surgeon may suggest tests to check whether the surgery went to plan. These may include an ultrasound scan and tests to see how well your sphincter muscle is working.
Your doctor may also investigate whether there is an underlying cause for the fissure. An underlying medical condition, such as Crohn’s disease or a sexually transmitted infection, could be causing the fissure. This means your fissure may heal if any underlying conditions are treated.
Your doctor may suggest trying the same treatment again, or another type of treatment, depending on your individual situation.
Your doctor might suggest other treatments instead of a sphincterotomy if you plan on getting pregnant, or if you’ve had a complicated birth. This is because you may be more likely to develop incontinence following a sphincterotomy.
You’ll usually be offered botulinum toxin (Botox) injections as a first option if self-help and medical treatments haven’t worked. Anal advancement flaps can also be another option for people who are at greater risk of developing incontinence.
Anal fistula surgery
An anal fistula is a tunnel that develops between the skin around your anus and the inside of your back passage (anal canal).
Anal fissure
An anal fissure is a small tear or ulcer (open sore) in your skin around the opening of your bottom.
Piles
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