Introduction
There are two types of procedures to correct an anal fissure:
- Botox injection into the internal anal sphincter.
- lateral internal sphincterotomy (LIS).
Procedure
The internal anal sphincter is composed of smooth muscle and controls wind and mucous leakage. It also helps control faecal incontinence, mainly passive faecal incontinence. In anal fissures, this muscle is most commonly overactive, or in spasm.
Botox relaxes smooth muscle. When injected into the internal anal sphincter, it has the effect of relaxing this muscle, thereby allowing increased blood to flow to the fissure to allow it to heal. As Botox wears off after 2-3 months, the effects are temporary. Injection of Botox can be performed under local anaesthetic, however a light anaesthetic in hospital as a Day Procedure is the preferred method by Dr Jamnagerwalla.
A lateral internal sphincterotomy (LIS) is generally a Day Surgery Procedure carried out under general anaesthetic. It involves making a small incision through the skin around the anus and cutting a small section of the internal anal sphincter to release the muscle spasm and allow the fissure to heal. The incision is closed with dissolving stitches. The success rate with a LIS is higher than that of a Botox injection, however the procedure and its risks are permanent.
Risks
The risks of anal fissure surgery include:
- Incontinence.
- Recurrence.
- Infection.
- Rarely, development of an anal fistula.
