Pre-operative Preparation for a Anal Sphincterotomy procedure
There is some important information about the pre-operative preparation for this procedure. It is imperative that you read this.
The objective is to release the spasm of the internal anal sphincter. The procedure is performed under general anaesthesia as a day case. Most fissures occur in the posterior midline just on the inside. At the left lateral aspect of the anus, a small incision is made through the skin and the lower part of the internal sphincter muscle is incised, thereby releasing the spasm. The wound is closed with a single absorbable suture. If there is a small skin tag associated with the fissure posteriorly this is also excised. No attempt is made to actually close the fissure as this makes no difference to the healing.
Post-operative Care following a Anal Sphincterotomy procedure
Following your procedure there are a number of things of which you need to be aware.
It is inevitable that you will experience some discomfort following your surgery in the region of where the sphincterotomy has been performed. As it is a relatively small incision this discomfort should be no greater than the pain you were experiencing from the fissure. Long acting local anaesthetic will have been injected into the wounds but after a few hours this effect will wear off. Before it does so it is important to have some pain killers on board and to continue these on a regular basis. You will be sent home with some pain killers - my preference is either Panadeine Forte or Nurofen. I recommend that you take these initially on a regular basis as directed on the packet. After about 48hrs it should be necessary to take these only as required.
It is important to maintain normal bowel activity after the surgery, but you would not normally expect a bowel motion for the first 2-3 days after your operation. Opening your bowels will increase the level of discomfort initially and it is important to keep yourself regular with an intake of adequate fibre. You should also drink plenty of water. If you feel that you are getting constipated then a fibre supplement such as Metamucil, Mucilax or Normocol should suffice.
A small amount of bleeding in the first two or three days is not unexpected, particularly with defaecation. If it appears excessive then simply apply some pressure with a gauze pad for 15-20mins.
You may experience swelling in the perianal region lasting for a few days but this will subsided of its own accord in due course.
The healing of the sphincterotomy wound and the fissure itself can be aided by simply cleaning the wound with soap and water in the shower, particularly once again after defaecation. Bathing the area in a warm salt bath may help your level of discomfort but probably won't alter the way the area heals. Infection is most unusual and if it does occur will usually settle of its own accord without the need for antibiotics. Any sutures will dissolve by themselves. If you think they have fallen out prematurely and the wound is gaping do not be alarmed - it will close by itself without the need for resuturing.
Resuming physical activity is largely one of common sense. Certainly moving around the house and going for short walks in the first couple of days is desirable. Anything more than this will be destined to cause more discomfort. An increase in the level of activity should be guided by the level of discomfort. You should be able to resume your normal day to day activities within a few days, so long as this does not include marked exertion. You should however be able to return to the gym or similar activities within a couple of weeks.
Dr Renaut does not routinely see his patients for a follow-up appointment. In most cases it is not necessary. If however you have concerns about your recovery then he is very happy to discuss these on the phone and he will arrange to see you if he thinks this is necessary. He routinely notifies your GP of all procedures and your progress.