Anal fissures are cracks or tears in the anus and anal canal and may be acute or chronic (meaning the time that they have been present). The primary symptom of anal fissures is pain
during and following bowel movements. Bleeding, itching, and a malodorous mucous discharge also may occur. They are often associated with a tendency to constipation. Anal fissures are easily diagnosed and evaluated by visual inspection of the anus and anal canal. On some occasions, flexible sigmoidoscopy or colonoscopy may be required.

Many fissures will heal by attention to the diet or with the use of laxatives. Plenty of fruit, vegetables and water in the diet will also help if other treatments are required.

GTN is an ointment that is effective in healing a fissure but it involves a six week course and can cause headaches. An alternative is diltiazem, which doesn’t cause headaches.

If these outpatient treatments do not work, then Botox injection into the internal anal sphincter is usually offered. This sufficiently relaxes the involuntary sphincter muscle to allow tears in the anal margin to heal and has very few risks. It is carried out under general anaesthetic as a day case.

The traditional cutting operation (lateral anal sphincterotomy) is rarely carried out these days because of the small risk of incontinence to wind following the procedure. Old-fashioned anal stretch procedures should never be carried out.

Botox injection and fissurectomy
You will usually have a pre-op assessment in the week before surgery where blood tests, chest X-ray and an ECG (heart recording) may be taken. You will be admitted a few hours before the approximate planned time of surgery having had nothing to eat for six hours before the start time (you may drink water up to two hours before your proposed time of surgery - with any of your regular medications). You will see your surgeon and the anaesthetist before your operation. After your surgery you will wake up in the recovery room, and then be transferred back to the ward. Later the same day you may have something to eat and drink if you wish. Most people are discharged home later the same day.

The procedure is usually done for pain and tends to be effective. Because of this it is not normally anymore painful than pre-operatively. However you will be provided with painkillers before discharge but it is recommended that if necessary you take regular paracetamol and ibuprofen (unless you are sensitive to these) after a few days of these. Stronger painkillers such as cocodamol are rarely necessary but if so it is important to take a laxative such as lactulose at the same time. You may drive a car when you are able to perform an emergency stop. There are no stitches to be removed.

You will be seen for follow-up six weeks following your surgery.

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