Sphincterotomy

WHAT YOU SHOULD KNOW:

• An anal sphincterotomy is a surgery to relax your anal sphincter (the ring of muscles that forms your anus). Your anus is the opening where stool leaves your body during a bowel movement (BM). Your anal sphincter controls the passage of your stools by opening or closing the anus. You may need a sphincterotomy if you have anal stenosis or an anal fissure. Anal stenosis is when your anal opening becomes very tight and stiff. An anal fissure is a cut or tear in the skin tissue just inside your anus. It may be caused by constipation (hard, dry stools), certain diseases, injury, and cancer or its treatment. With an anal fissure, you will usually have pain and bleeding around your anus after a BM.
  
  
• Your caregiver may want you to have a sphincterotomy if other treatments do not work for you. You also may need surgery if your anal fissure is very painful. With an anal sphincterotomy, your caregiver will cut your sphincter just enough to allow it to relax. This helps decrease the pressure around your sphincter. It may then increase the blood flow to your anal tissue. Having a sphincterotomy may heal your anal fissures and may help stop them from occurring again. A sphincterotomy also may help relieve pain and bleeding around your anus.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Having a sphincterotomy may cause bleeding or an infection. You may pass gas more than usual or feel the need to have a BM right away. You may have diarrhea (loose, watery stools). You may have trouble controlling your BMs. Your sphincter or other parts of your intestines may be damaged. If you have anal fissures, surgery may cause you to have anal stenosis. You may get another anal fissure. You may need another surgery to correct these problems.
  
  
• If you do not have a sphincterotomy, your anal fissure may not heal and may become worse. You may have trouble having BMs. The pain and bleeding in your anus may continue. You may develop more anal fissures or skin tags (extra skin growth). You may develop an abnormal opening from your anus to nearby body organs. Your anal fissure may become so deep that your caregiver may be able to see your sphincter muscles. Call your caregiver if you have questions or concerns about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Nasogastric (NG) tube: An NG tube is put into your nose, and passes down your throat until it reaches your stomach. Food and medicine may be given through an NG tube if you cannot take anything by mouth. The tube may instead be attached to suction if caregivers need to keep your stomach empty.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.

During your surgery:

• Your caregiver may do an open or closed sphincterotomy. During an open sphincterotomy, your caregiver uses a special knife to cut the skin tissue covering your sphincter. This allows him to see your sphincter muscles. He makes this cut away from any anal cracks or tears.
  
  
• During a closed sphincterotomy, your caregiver cuts the sphincter muscles without cutting through the skin tissue. He uses a special scope to help him see your sphincter. If you have anal stenosis, your caregiver may make one or two cuts in your sphincter. Once your sphincter is cut, the pressure is released and the muscles relax. Your caregiver then either closes the cut with stitches or leaves it open to heal. Your anus may then be covered with a bandage.

After your surgery:

You will be taken to a room where you can rest until you are fully awake. Caregivers will watch you closely for any problems. You will then be taken back to your hospital room. Do not get out of bed until your caregiver says it is okay.

• Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.
  
  
• Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
  
  
• Steroids: Steroids may help your anal muscles relax and increase blood flow to your anus. This medicine also may decrease your pain. Steroid cream may be put just inside your anus. Your caregiver will teach you the right way to use this medicine.