Sphincterotomy

WHAT YOU SHOULD KNOW:

• An anal sphincterotomy is surgery to relax your anal sphincter (the ring of muscles that forms your anus). Your anus is the opening where the stool from your bowel movements (BM) leaves your body. Your anal sphincter controls the passage of your stools by opening or closing the anus. You may need a sphincterotomy if you have an anal fissure or anal stenosis. 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 may also 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 may also help relieve your pain and bleeding around your anus.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. 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 and you may soil your underpants. 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: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• 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: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
  
  
• Nasogastric (NG) tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty. You may need a NG tube if your stomach gets too full or if you throw up a lot after surgery. You may also need it if you cannot use your mouth to eat. An NG tube may also be used to help get your bowels working. Food or medicine may be given through your NG tube.
  
  
• Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.

During your surgery:

• You are taken to the room where your surgery is done. You are then moved from a stretcher to a special table for 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 you 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 OK.

• Medicines for pain, swelling, or fever: You may be given medicines to treat pain, swelling, or fever while you are in the hospital. 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, a history of bleeding in your stomach, or any other medical problems. Also tell your caregiver about any allergies you have to medicines. Tell your caregiver about all other medicines, herbs, and supplements that you have taken lately.
  
  
• Stool softeners: You may be given stool softeners to soften your bowel movements, making them easier to pass.
  
  
• Topical medicine: Topical medicine may help your anal muscle relax and increase blood flow to your anus. This medicine may contain anesthesia to help decrease your pain. Topical medicine may be put just inside your anus. Your caregiver will teach you the right way to use topical medicine.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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