What is a lateral internal sphincterotomy?
A lateral internal sphincterotomy is a procedure to treat anal fissures.
What is an anal fissure?
An anal fissure is a tear in the skin around the back passage. It is a common problem that causes severe pain, especially after a bowel movement. It may also cause bleeding.
The condition is associated with spasm of the internal anal sphincter. This reduces the blood supply to the area and prevents healing. The treatment is aimed at breaking this cycle to allow healing to take place (see figure 1).
What are common symptoms of an anal fissure?
The main symptom is severe pain during or after a bowel movement, which can last for several hours. People often describe the discomfort as ‘like passing a piece of broken glass’. Sufferers may delay going to the toilet because of the pain and become constipated. Passage of the resulting hard faeces then causes further tearing, and worsens the condition.
What are the benefits of surgery?
Surgery is effective at treating an anal fissure but is usually recommended to people who fail to get better with non-surgical treatments.
Are there any alternatives to sphincterotomy surgery?
There are simple treatments which may help such as laxatives, ointments, injections of botulinum toxin, eating more fibre and drinking more fluid.
One treatment for anal fissures is to use a special nitrate ointment to relax the sphincter muscle, reducing spasm and easing the pain, and allowing the fissure to heal. Many people however may find applying the cream inconvenient or embarrassing, and can get headaches, sometimes so severe that it prevents them from using it.
What does the operation involve?
Sphincterotomy simply means dividing the sphincter. The operation is usually performed under a general anaesthetic and takes about a quarter of an hour.
Your surgeon will make a small cut in the skin near your back passage. They will then cut the lower part of the internal sphincter muscle. This will relieve the spasm in the sphincter, allowing a better blood supply to heal the fissure.
What complications can happen?
General complications of any operation:
- Infection in the surgical wound
Specific complications of this operation:
- Involuntarily passing wind or loose faeces
- Difficulty passing urine
- Permanent incontinence from the bowel
How soon will I recover?
You should be able to go home the same day. The pain from the fissure should improve rapidly. It is usually possible to return to work after a few days depending on your type of work.
Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice. Most people make a full recovery and can return to normal activities. Occasionally the fissure comes back.
Sphincterotomy, lateral internal summary
An anal fissure is a common condition that causes a lot of pain. At first, it may be treated with ointments or botulinum toxin. If this fails, surgery is the best option for a cure.
How to pay for your operation
Lateral internal sphincterotomy costs are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own treatment the cost of the operation will be explained and confirmed in writing when you book the operation. Ask the hospital for a quote beforehand, and ensure that this includes the surgeon’s fee, the anaesthetist’s fee and the hospital charge for your procedure.
Author: Mr Ayan Banerjea MRCS, Mr Jonathan Lund DM FRCS (Gen. Surg.) and Miss Gillian Tierney DM FRCS (Gen. Surg.)
Illustrations: Medical Illustration Copyright © 2007 Nucleus Medical Art. All rights reserved.
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