Anal Fissures: Surgical Options and Risks Explained - Surgery

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Anal fissures are small tears in the lining of the anal canal, often caused by trauma during bowel movements, particularly when passing hard or large stools. They can lead to significant discomfort, bleeding, and a cycle of pain that can make bowel movements even more difficult. Your situation, having experienced recurrent anal fissures after hemorrhoid ligation, is not uncommon. The tightness of the anal sphincter, which can result from previous surgical interventions, may contribute to the development of fissures, as you have noted.

When conservative measures, such as dietary adjustments to increase fiber intake, hydration, and the use of stool softeners, fail to provide relief, surgical options may be considered. One common surgical intervention for chronic anal fissures is a lateral internal sphincterotomy. This procedure involves making a small incision in the internal anal sphincter muscle to relieve tension and allow the fissure to heal.
However, the decision to proceed with a sphincterotomy should be made with caution. While this surgery can be effective in promoting healing and alleviating pain, it does carry risks. One of the primary concerns is the potential for postoperative complications, including anal incontinence. This risk is particularly relevant for older patients or those with pre-existing conditions that may affect muscle tone and control. Studies suggest that while the incidence of significant incontinence following sphincterotomy is relatively low, it can still occur, and the risk may increase with age or if the patient has had prior surgeries in the area.

In your case, given that you have experienced fissures for over three years and that conservative management has not been successful, it may be worth discussing the potential benefits and risks of a sphincterotomy with a colorectal surgeon who specializes in anal disorders. They can provide a thorough evaluation of your specific situation, including the severity of your fissures, the condition of your anal sphincter, and any other contributing factors.

It is also essential to consider alternative treatments before opting for surgery. Some patients find relief through the use of topical medications, such as nitroglycerin ointment or calcium channel blockers, which can help relax the anal sphincter and promote healing. Additionally, botulinum toxin injections into the sphincter muscle have been shown to be effective in some cases, offering a less invasive option with a lower risk of incontinence.

Ultimately, the decision to undergo surgery should be based on a comprehensive assessment of your symptoms, lifestyle, and the potential impact on your quality of life. If surgery is deemed appropriate, ensure that you have a detailed discussion with your surgeon about the expected outcomes, recovery process, and any precautions you can take to minimize the risk of complications.

In summary, while a sphincterotomy can be a viable option for chronic anal fissures, it is crucial to weigh the benefits against the risks, particularly concerning anal incontinence. Consulting with a qualified colorectal surgeon will help you make an informed decision tailored to your specific needs and circumstances.