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Introduction
Anal fissure is a common medical condition that causes a great deal of pain. It is a small tear within the thin, moist tissue that lines the anus. It usually occurs when hard or large stools are passed during a bowel movement.

Anal Fissure generally causes pain and bleeding with bowel movements. At first, it can be treated with ointments or botulinum toxin. If this fails, surgery is the most suitable choice for a cure.

Anal fissures could be either,

  • Acute fissure: is a superficial tear and a short-run condition.
  • Chronic Fissure: is deeper and exposes the underlying muscle.

Sphincterotomy, usually a lateral internal Sphincterotomy, is a simple surgery during which the sphincter, the circular group of muscles surrounding the anus responsible for controlling bowel movements, is cut or stretched.

When is Sphincterotomy needed?

  • The doctors usually recommend Sphincterotomy for the following cases:
  • Pain, typically severe, during bowel movements
  • Pain after bowel movements that may last up to several hours
  • Bright red blood on the stool after a bowel movement
  • A visible crack within the skin around the anus
  • A small lump or skin tag on the skin close to the anal fissure


Causes of Anal Fissure
Some of the causes of Anal Fissure are:

  • Crohn's illness or inflammatory bowel disease
  • Anal cancer
  • HIV
  • Tuberculosis
  • Syphilis
  • Passing large or exhausting stools
  • Constipation and straining during bowel movements
  • Chronic diarrhea

Treatment
Sphincterotomy is usually performed using the following techniques:

  • The open technique involves making an incision across the intersphincteric groove, separating the internal sphincter from the anal mucous membrane by blunt dissection, and dividing the internal sphincter using scissors.
  • The closed technique, also called the subcutaneous technique, involves the doctor making a small incision at the intersphincteric groove. A surgical knife is then inserted with the blade parallel to the internal sphincter, advancing it along the intersphincteric groove. Then the scalpel is rotated towards the internal sphincter, dividing it.

Procedure
The surgery is done under a general anaesthetic. The surgeon will first make a small cut within the skin of the anal canal to reach the anal sphincter (the muscle around your anal canal). This ring of muscle controls the gap and closing of the anus.

The surgeon will try to relax the sphincter and stop it from going into a spasm by making a small cut in it. This may allow the fissure to heal. The small skin wound may be sewed or left open to heal naturally. After that, a pad or dressing will be put onto the anus to help stop the bleeding.

Post-Procedure
The doctor will recommend the following after the procedure:

  • Get lots of rest.
  • Try to walk a little each day.
  • Shower or bathe as normal, however, always pat the anal area dry afterward.
  • Drink plenty of fluids.
  • Eat a high-fibre diet.
  • If the patient has constipation, take a light laxative or stool softener.
  • Sit in around ten centimeters of warm water 3 times daily and also following the bowel movements till the anal area heals and the pain is gone.
  • Use a little step to support the feet for the bowel movement. This will help flex the hips and place the pelvis in a squatting position making the passing of stool easier.
  • Avoid using fragranced soaps.

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