Surgery for anal fissure

Patient

Q: Thank you for your reply once again. I just saw a gastroenterologist who in turn transferred me to see a surgeon. The verdict from the visual inspection, as it was too painful to conduct any other examination is that I have an anal fissure, a chronic one. The surgeon suggested surgery. The circular muscle which has been in constant spasm and causing the pain needs to be somehow operated on. He says that this operation will relieve the situation and relax the muscle which will allow the fissure to heal. My questions are: Is this the only solution? and Does making a cut at three o'clock location on the muscle indirectly cause the fissure at six o'clock to heal?

Doctor

A:   Surgery is not the only therapy available to treat anal fissures. However, surgery remains the 'gold standard" of therapy. That is, it is the treatment option to which all other therapies are compared. Medical treatments such as localized injections of calcium channel blockers, nitroglycerin and and botulinum toxin have all been shown to provide some relief of symptoms and in some cases may cure the condition. However, the length and cost of therapy is often times greater than when surgery is performed.
The operation suggested by your surgeon is called a lateral sphincterotomy. This procedure reduces spasm and therefore reduces pain. It also allows for greater blood flow to area which in turn allows the fissure to heal.

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