Anal Fissures are tears in the skin around the anus. They are usually caused by severe constipation, with passage of hard stool along with straining tears the skin. They can be very painful, usually described as sharp burning or tearing pain while having a bowel movement. The pain is primarily due to spasms in the nearby sphincter muscle.
Most anal fissures will heal on their own with proper bowel management. Stool softeners, fiber supplements, high fiber diet, increasing water intake, and laxatives will keep you from straining and passing hard stools, which will allow the fissure to heal. Narcotic pain medications should be avoided because they worsen constipation. Topical pain medications can help greatly. The most commonly used is a nitroglycerine ointment. When applied to the anal area it reduces the spasm in the sphincter muscle, lessening the pain and making bowel movements easier to allow healing.
If these measures fail to heal your fissure, you may need surgery. The best surgery for anal fissures is called a lateral internal sphincterotomy, which involves dividing the internal layer of the anal sphincter to stop the painful spasms and allow healing. For fissures that are large or still will not heal, the area may need to be cut out or repaired by covering with adjacent tissue.
Prior to anal fissure surgery, you will be asked not to eat or drink anything after midnight prior to your surgery. You will be given specific instructions from your surgeon or anesthesiologist about which medications you should or should not take prior to your surgery. You should not take any blood thinning medications at least 5 days prior to your operation. This should be discussed with your surgeon at your preop visit.
You will probably be given instructions for a bowel prep. Various bowel preps may be used, but this typically involves an enema and / or laxative taken the night before and the morning of surgery. This may vary depending on exactly what procedure you are having and your surgeon's preference. Talk to your surgeon about your bowel prep.
Your recovery will vary depending on the type of Anal Fissure surgery you have.
You may resume activity gradually beginning shortly after surgery. You should begin walking the night of surgery or the following morning and continue to increase as you are able. Increased activity reduces the risk of blood clots, and improves breathing to prevent pneumonia.
Depending on the type of surgery you have, you may have significant limitation in sitting or walking for long periods of time. A soft pillow or donut pillow will help to displace the pressure of sitting away from the site of your surgery.
Avoid driving until you no longer need narcotic pain medication. Driving while taking them can impair your ability to drive safely.
You should be able to return to work within 1-4 weeks after surgery, depending on what type of Anal Fissure surgery you had.
The most important part of caring for your wounds after anal fissure surgery is keeping the area clean and dry.
Sitz baths should be done 3 times a day and after any bowel movement. This involves sitting in warm soapy water to clean the area. Hand-held shower nozzles are very effective for this. Showering after every bowel movement is also effective. You should avoid excessive wiping, as toilet paper may irritate the skin or incisions around the anus. Moist toilettes or baby wipes are preferred.
Sometimes the skin around the anus and the anal fissures will be left open or separate after surgery. Sitz baths, showering and moist toilettes should be used as above.
Bloody and / or mucous drainage and stool leakage is common for the first several days after anal surgery and may last up to a week or more. You will probably want to place gauze or absorbent material such as feminine napkins over the area to protect your underclothes. Long-term fecal (stool) incontinence can occur after sphincterotomy, but this is uncommon.
Contact your surgeon if significant bleeding occurs.
Usually you may shower beginning the day after surgery.
If you have wet-to-dry dressing changes or packing that must be changed periodically, be sure to follow the instructions for the dressing or packing changes.
If you notice redness spreading onto the surrounding skin, develop fever, or have severe amount of bleeding or bleeding that lasts for more than a week, contact your surgeon.
Medications - Pain Management
Pain can be fairly severe after surgery, particularly with bowel movements. You will be discharged with pain medication, typically a mild to moderate strength narcotic, depending on the type and extent of surgery you had. Take as needed and as prescribed. You may also take over-the-counter medications such as ibuprofen for pain. Most narcotic medications prescribed are combined with Tylenol (acetaminophen) and you should not take additional Tylenol if you are taking a narcotic medication that already contains Tylenol. Narcotics can cause constipation, so it is very important to take stool softeners and any bowel regimen prescribed to you after anal surgery.
Pain with bowel movements will be limited by ensuring you have regular, soft bowel movements that do not require prolonged sitting or straining. Don't be afraid to go after surgery � you won't hurt anything back there! See below for bowel regimen.
Unless otherwise instructed, you should be able to resume your usual home medications the night of or the morning following your surgery.
Click here for more detailed information on commonly prescribed medications.
Diet & Bowel Care
You will be prescribed a bowel regimen when you go home, typically a stool softener, fiber supplement and, possibly, a laxative. This is vital to enable you to have soft bowel movements after surgery to protect the incisions made AND to prevent your Anal Fissures from coming back. You may also be given nausea medication if you have experience nausea or vomiting from taking your pain medication.
Over the counter medications can treat this well. Senna, Miralax, or dulcolax are some of the most common laxatives and are available at most drug stores or grocery stores. Take as directed by your surgeon.
You should drink at least 6-8 glasses of water a day. This will help you have soft, regular bowel movements. Particularly with anal fissures, a high fiber is important to prevent their return. If you were on a high fiber diet for medical treatment of your fissures, resume that diet postop. You may want a nutrition consult if you are unfamiliar with high fiber diets and what kinds of foods are included.
If you are having trouble having a bowel movement AND have abdominal bloating, nausea
or vomiting, and not passing gas, you should call your doctor.
You may resume your regular diet with no restrictions. As mentioned above, high fiber diet and / or fiber supplements are important.
If you are having trouble having a bowel movement AND have abdominal bloating, nausea or vomiting, and not passing gas, you should call your doctor.
You will be given a date and time to see your surgeon following surgery, usually in 10 days to 3 weeks. If you are discharged late in the day or over the weekend, you will be given a number to call the following business day for an appointment. If you are having trouble making an appointment, call your doctors' office directly for assistance.
Call Your Doctor If: