What is Lateral Internal Sphincterotomy

Lateral internal sphincterotomy is a surgical procedure to treat an anal fissure. An anal fissure is a painful tear inside of the opening of the anus (anal canal).

During this procedure, the muscle that controls the anal canal (internal anal sphincter) will be divided. This relaxes the anal opening and helps the fissure heal.

You may need this procedure if other treatments for your anal fissure have not worked.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Difficulty controlling bowel movements (incontinence).
• Development of hemorrhoids.
• Return (recurrence) of the fissure.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• You may be instructed to take a laxative and a have an enema before the procedure (bowel prep). Follow your health care provider’s instructions.
• You may have a rectal exam with a lighted scope (proctoscope).
• Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

• To reduce your risk of infection:

• Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• You will lie face-down with your buttocks raised. Tape will be used to spread the cheeks of your buttocks.
• A surgical instrument (anal speculum) will be inserted to widen your anal canal and view the opening.
• An incision will be made along the side of your anal canal. The incision will continue down to the muscles of your internal anal sphincter.
• Your surgeon will cut through the internal anal sphincter.
• The skin over the internal anal sphincter will be closed with an absorbable stitch (suture).
• A bandage (dressing) may be placed over your incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may continue to receive fluids and medicines through an IV tube until you can eat and drink on your own.
• You will be given pain medicine as needed.
• Do not drive for 24 hours if you received a sedative.

Lateral Internal Sphincterotomy, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Rectal pain, especially during a bowel movement.
• Some blood-tinged rectal discharge.

Follow these instructions at home:

Bathing

• Take sitz baths as told by your health care provider. A sitz bath is a warm water bath that is taken while you are sitting down. The water should only come up to your hips and should cover your buttocks. You may be instructed to take several sitz baths a day.
• Remove your bandage (dressing) before a bowel movement or bath. If you have rectal discharge, apply a clean dressing after your bowel movement or bath.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Change your dressing as told by your health care provider.
  • Wash your hands with soap and water before you change your dressing. If soap and water are not available, use hand sanitizer.
  • Leave stitches (sutures) in place. The stitches will absorb over time.
• Check your rectal area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Pus.

Driving

• Do not drive for 24 hours if you received a medicine to help you relax (sedative) during your procedure.
• Ask your health care provider when it is safe for you to drive.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider approves.

General instructions

• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider. This includes laxatives or stool softeners.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have pain that does not get better with medicine.
• You become constipated.
• You have more redness, swelling, or pain around your rectal area.
• You have more fluid or blood coming from your rectal area.
• You have pus coming from your rectal area.