Chronic anal pain, rectal bleeding, and discomfort can significantly impact daily life, often requiring more than just conservative treatment approaches. A sphincterotomy is a surgical procedure that has become the gold standard for treating specific anal conditions, particularly those involving persistent pain and healing difficulties. This targeted surgical technique offers relief to many patients when other treatments haven’t resolved their symptoms. The procedure focuses on addressing problems with muscle tension in the anal canal, providing a solution for patients who have struggled with ongoing discomfort and related complications.

What is a Sphincterotomy?

A sphincterotomy, also known as lateral internal sphincterotomy, is a surgical procedure that involves making a small, precise incision in the internal anal sphincter muscle. This muscle forms part of the anal canal and plays a crucial role in bowel control. The anal canal contains two main sphincter muscles working together to maintain continence—the internal sphincter, which operates automatically, and the external sphincter, which provides voluntary control.

The internal anal sphincter muscle normally remains partially contracted at rest, and when this muscle becomes too tight or fails to relax properly, it can lead to various problems, particularly chronic anal fissures that don’t heal with standard treatments. A sphincterotomy specifically targets this internal sphincter muscle through a carefully controlled incision, reducing excessive pressure while preserving continence.

Clinical experience has shown sphincterotomy to be highly effective, with success rates often exceeding 90% for properly selected patients. This high success rate, combined with relatively low complication rates, has established the procedure as the primary surgical treatment for chronic anal fissures that don’t respond to non-surgical options. The procedure’s effectiveness stems from its ability to directly address excessive muscle tension that impairs blood flow to the anal canal lining.1

When Is Sphincterotomy Recommended?

A sphincterotomy becomes an option when non-surgical approaches haven’t provided adequate relief. The decision to proceed with surgery involves careful evaluation of the patient’s symptoms and medical history. Before considering surgical intervention, patients typically try various treatments, including topical medications like nitroglycerin ointment or calcium channel blockers. Some patients might also receive Botox injections as an intermediate step before surgery. Common situations where a sphincterotomy might be considered include:

  • Chronic anal fissures: When fissures persist for more than 8-12 weeks despite medications, dietary changes, and other standard treatments.
  • Severe pain: Patients experiencing significant pain during bowel movements that substantially impacts their quality of life.
  • Sphincter spasm: Cases involving persistent muscle tension in the anal canal that prevents healing and causes ongoing discomfort.
  • Recurring problems: Situations where fissures keep returning even after proper healing, suggesting an underlying muscle issue.
  • Treatment resistance: Cases where approaches like sitz baths, stool softeners, and topical medications haven’t provided relief.
  • Complex conditions: Some patients with anal fistulas, abscesses, or other anorectal conditions might benefit from a sphincterotomy as part of their treatment.
  • Fissurectomy: In cases where scar tissue or recurring fissures are a concern, a fissurectomy may also be considered as part of treatment.
  • Inflammatory bowel disease: Patients with inflammatory bowel disease who experience chronic anal fissures may also be candidates for a sphincterotomy if non-surgical options prove ineffective.

The Sphincterotomy Procedure

A sphincterotomy takes place in a surgical setting under appropriate anesthesia, typically as an outpatient procedure. Before surgery, patients undergo a physical examination and medical history review to ensure the procedure is appropriate and safe. The colorectal surgeon may also perform additional tests to confirm the diagnosis and evaluate the anal canal’s condition.

The surgeon begins by using an anoscope to carefully examine the anal canal, confirming the location and extent of any fissures or other issues requiring attention. They then create a small incision in the internal anal sphincter muscle, typically on the left side—hence the term “lateral internal sphincterotomy.” This precise technique targets only the internal sphincter, preserving the external muscle that maintains voluntary control. The incision is often made with a small scalpel to ensure precision.

Most patients receive local anesthetic with sedation, though some cases might require general anesthesia based on individual circumstances. The surgeon may also remove damaged tissue during the same procedure if necessary to promote better healing. In many cases, the small surgical site heals without requiring sutures. The entire process typically takes less than 30 minutes, and the small incision often heals without requiring sutures, reducing the risk of complications.

By reducing excessive tension, the procedure improves blood supply to the anal canal lining, promoting healing. This increase in blood flow is crucial in helping chronic fissures heal and reducing the chances of recurrence.2

Recovery and Aftercare

After a sphincterotomy, most patients notice immediate improvement in their symptoms, though complete healing takes several weeks. During initial recovery, mild discomfort or slight bleeding is common but typically resolves quickly. A successful outcome depends largely on following proper aftercare instructions and maintaining good communication with your healthcare team.

Some patients experience temporary changes in continence during healing, such as occasional soiling, fecal incontinence, or decreased control of gas. These symptoms typically resolve as the area heals and the sphincter muscle adapts to its new configuration. Most people return to normal activities within a few days, though complete healing may take 6-8 weeks. Important aftercare measures include:

  • Sitz baths: Soaking in warm water for 10-15 minutes, several times daily, especially after bowel movements.
  • Pain management: Following prescribed medication schedules and using cold packs as directed.
  • Dietary care: Maintaining a high-fiber diet and drinking plenty of fluids to prevent constipation.
  • Activity limits: Avoiding strenuous activities and heavy lifting during initial recovery.
  • Hygiene: Using soft toilet paper and gentle wiping techniques to avoid irritating the surgical site.
  • Bowel care: Using prescribed stool softeners and, if necessary, a mild laxative to avoid straining during bowel movements.

Contact Cary Gastro for Expert Care

Chronic anal pain, anal fissures, and related conditions can significantly impact your quality of life, but effective surgical solutions are available. If you’re struggling with persistent symptoms that haven’t responded to standard treatments, the experienced colorectal specialists at Cary Gastro can help determine if a sphincterotomy might be right for you. Our team provides comprehensive evaluation, treatment, and follow-up care, ensuring you receive the most appropriate care for your specific situation. Contact us today to request an appointment and take the first step toward finding relief.


1https://www.ncbi.nlm.nih.gov/books/NBK493213/
2https://jamanetwork.com/journals/jama/fullarticle/2776331