Anal Fissure/Fistulotomy/Sphincterotomy Surgery
What is an Anal Fissure?
An anal fissure is a tear in the skin inside the anal canal. When this skin is torn, you may have pain with each bowel movement and pass bright red blood.
What is a Sphincterotomy?
Sphincterotomy surgery allows a fissure or fistula to heal. A small part of the anal sphincter muscle is cut to open the anal canal. This relieves pressure when you move your bowels and allows a fissure to heal.
What is a Fistula?
An infection of the gland inside the anus can cause it to fill with pus. This is an abscess. After the abscess is drained, there may be a tunnel from the anus to the skin. This is a fistula. A fistula can cause pain, fever, and drainage.
What is a Fistulotomy?
A fistulotomy is surgery to open a fistula allowing it to heal.
Day Before Surgery: Bowel Prep.
An important part of preparing for surgery is emptying your bowel. You need to buy 1 bottle - Magnesium Citrate 10 oz. and 2 Fleets Phosphate enemas. Buy these at a pharmacy. You do not need a prescription.
- Eat a light breakfast and lunch.
- Drink only clear liquids after lunch until midnight (there is no limit on how much you may drink)
Examples of clear liquids
Juice without pulp: grape, apple or cranberry
Clear Jell-O®, no fruit in it
Carbonated beverages, clear sodas
Weak coffee or tea, no milk or creamer, sugar or substitute okay
No alcoholic beverages of any kind
No dairy products of any kind
Boost Breeze® or Resource®
- At 2 pm, drink Magnesium Citrate 5 oz. (½ bottle). Shower after bowel movement.
- You may continue to drink only clear liquids until midnight.
- The morning of surgery, before you come to the hospital, give yourself the first enema 1½ hours before you leave home. Give yourself the second enema 1 hour before you leave home. Shower after results of the second enema.
- Take a sitz bath at least 3-4 times a day and after each bowel movement. This will help decrease the pain of rectal spasms and aid healing. Sit in a bathtub of warm water for 10-20 minutes.
- Avoid hard wiping of the anal area for the first few days. Do not use toilet paper, instead, use alcohol-free baby wipes.
- You will have reddish-yellow drainage from the rectum for at least 7-14 days. You will need mini-pads or sanitary pads for your undergarments during this time. The drainage will decrease in amount and become lighter in color. With bowel movements and increased activity you may notice an increase of bloody drainage.
- While on pain medicine, you need to take a stool softener (Docusate sodium) and a bulk fiber laxative such as Metamucil® to prevent constipation
- Avoid sitting or standing for longer than 1 hour at a time.
For the first 6 weeks, do not lift more than 10 pounds. Lifting puts extra strain on the surgical area and increases the chances of bleeding.
- Do not drive while on narcotic pain medicine.
- Check with your doctor before returning to work.
- Sexual activity may be resumed when you are comfortable.
- You will return to see your surgeon 1 - 3 weeks after surgery.
Your doctor will order pain medicine for you. Do not drink alcoholic beverages, drive a car or operate machinery while you are on the narcotic pain medicine.
You should avoid constipation while you are taking pain medicine. Both a fiber supplement and a stool softener will be ordered for you. These will help the stool pass more easily.
Eat a well balanced, high fiber diet each day:
- 8-10 (8 oz) glasses of non-caffeinated fluid
- At least 4 servings of fruits and vegetables
- At least 4 servings of breads and cereals (2 of these should be whole grain)
When to Call the Doctor
- Large amounts of bright red blood from the rectum that does not stop with pressure to the rectum for 10 minutes
- Temperature over 100.4º F for 2 readings taken 4 hours apart. Take your temperature once a day for a week.
- Foul-smelling drainage
- Breaking open of suture line
- Excessive swelling in the rectal area
- Unable to control bowel movements
- Trouble passing urine.
Digestive Health Center: (608) 890-5000.
After hours, weekends or holidays this number will be answered by the paging operator. Ask for the doctor on call or ask for Dr. Harms, Heise, Kennedy, or Foley. Leave your name and phone number with area code. The doctor will call you back.
If you live out of the area, call (855) 342-9900.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 04/24/2013
Copyright © 02/26/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5467
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