Sphincterotomy: What You Need to Know

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C
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Sphincterotomy is a surgical procedure to help heal an anal fissure when more conservative treatments are ineffective. Anal fissures are common and can cause severe pain, bleeding, and itching.  This procedure cuts the sphincter muscle to relieve pressure and allow the fissure to heal. It has a high success rate of 96–100%

This article explains why you may need a sphincterotomy and what to expect. It also discusses recovery time and some potential risks of the procedure. 

Why do doctors perform sphincterotomy?

A doctor preparing surgical instruments
VICTOR TORRES/Stocksy United

If home treatments or prescription medications cannot heal an anal fissure, your doctor may recommend sphincterotomy.

An anal fissure is a tear in the tissue lining the anus or lower rectum. This causes the internal anal sphincter to spasm, restricting blood flow, causing pain, and impairing healing.

Anal fissures are common in middle-aged adults and children, with an estimated 342,000 new cases occurring every year in the United States. Doctors consider anal fissures that last more than 6 weeks to be chronic. Chronic fissures tend to be more difficult to treat.

Researchers estimate that about 40% of people with acute anal fissures later develop chronic fissures. Acute fissures are usually superficial tears, but chronic fissures may extend deep into the muscle fibers of the sphincter and be difficult to heal.

What will doctors try before recommending surgery?

Before recommending surgery, a doctor may suggest attempting some at-home treatments, such as stool softeners, increased water consumption, a high fiber diet, and warm sitz baths. If these treatments are ineffective, the doctor may recommend topical analgesics, such as nifedipine, nitroglycerin, or lidocaine jelly.

Topical nifedipine and nitroglycerine work by relaxing the sphincter muscle and increasing blood flow, which promotes faster healing.

It is important to talk with the doctor about potential medication side effects. Nitroglycerin may cause headaches, heart palpitations, and nausea

Oral calcium channel blockers and botulinum toxin (Botox) injections may also be potential treatments for chronic fissures. Botox provides significant pain relief and is usually more effective than topical medications or calcium channel blockers. 

These pharmacological treatments have a 65–75% success rate, but they will not be as effective as surgery. If none of these nonsurgical treatments work, the doctor will most likely recommend sphincterotomy to treat your fissure.

Learn more about anal fissures.

It is important to note that if you have fecal incontinence, you may not be a good candidate for sphincterotomy. A surgeon may suggest an alternative surgery depending on the cause of your incontinence.

How do you prepare for a sphincterotomy?

Your doctor will need a list of all your current medications and supplements before surgery. They will tell you which ones you will need to stop taking and when. They will also tell you when to stop eating and drinking and whether you should take any medications on the morning of your procedure. 

This procedure is a same-day surgery with anesthesia, so you will need to arrange a ride home.

How do doctors perform a sphincterotomy?

The surgeon may choose to give you a local anesthetic or light sedation before the surgery. It is a relatively short procedure, lasting up to 30 minutes.

The goal of the procedure is to release the pressure in your sphincter so that your fissure can heal.

There are two surgical approaches for sphincterotomy: open and closed.

Open sphincterotomy

The open procedure requires an incision near the anal skin to expose the internal sphincter muscle. The surgeon will lift the muscle and divide it using a knife. Cutting the sphincter will relieve pressure in your anus.

Closed sphincterotomy

The closed procedure does not begin with a skin incision. Instead, the surgeon will feel for the groove between the internal and external sphincter muscles and use a scalpel to separate them.

What can you expect after a sphincterotomy? 

A 2020 study found that anal fissures were almost completely healed 8 weeks after sphincterotomy. You may be able to resume your usual activities a week or two after surgery.

You may notice a small amount of bleeding or drainage from the anus for a few days after surgery. Some people may also experience additional complications, such as incontinence or infection.

What are some of the risks of sphincterotomy?

There may be some temporary stool or gas incontinence following your surgery. This is more common in females than males.

There also may be excessive bleeding, which occurs more frequently with the open surgical procedure. A small percentage of people who undergo the closed technique may develop a perianal abscess in the space that appears following the separation of the anal mucosa.

Fissure recurrences are possible but relatively rare. It is important to eat a high fiber diet and drink enough water to prevent constipation. If your fissure returns due to an unknown cause, the doctor may recommend further testing.

Frequently asked questions

Below are the answers to some common questions about sphincterotomy. Cynthia Taylor Chavoustie, MPAS, PA-C has medically reviewed the answers.

How effective is sphincterotomy?

Sphincterotomy is a very successful treatment method for anal fissures. It has a 96–100% success rate.

Is sphincterotomy painful?

The surgery itself will not be painful, as doctors will administer a local or general anesthetic before the procedure. Many people have residual soreness for a few days after the surgery.

Summary

Sphincterotomy is an effective surgical procedure with a high success rate. Anal fissures are common and may resolve with at-home treatments or prescription medications. If your fissure does not resolve with more conservative treatments, your doctor may recommend this surgery.

Not everyone is a good candidate for this procedure, so it is important to discuss your treatment options and the associated risks with a doctor.

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Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2022 Sep 1
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