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.

GETTING READY:

Before your surgery:

• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Your caregiver may ask you questions about your symptoms. You may need to have blood tests. Your caregiver may do an ultrasound, which may help him plan your surgery. He may use a scope to look at your bowels and measure the tightness of your sphincter. Your caregiver may also take samples of your anal tissue and send it to a lab for testing. This may help your caregiver understand the cause of your anal fissure. Ask your caregiver for more information about these and other tests that you may need.

The night before your surgery:

• Ask caregivers about directions for eating and drinking. Your caregiver may want you to only drink liquids. He may also give you a special powder that is mixed with liquid. This drink is called a bowel preparation and will cause you to empty your bowels. Ask your caregiver for directions on how much and what kinds of liquids to drink.
  
  

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

TREATMENT:

What will happen:

• You will be taken to the room where your surgery will be done. You will be given anesthesia medicine to make you comfortable and pain free during your surgery. Your sphincterotomy may be open or closed. During an open sphincterotomy, your caregiver will cut into the skin tissue covering your sphincter. This will allow him to see your sphincter muscles. He will make his cut away from any anal cracks or tears.
  
  
• During a closed sphincterotomy, your caregiver will cut the sphincter muscles without cutting through the skin tissue. He will use 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 will be released and the muscles will relax. After your sphincterotomy, your caregiver will either close the cut with stitches or leave 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.

Waiting room: This is a room where your family and friends can wait until you are ready for visitors. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

• You cannot make it to your surgery.
  
  
• You are unable to have a BM.
  
  
• You have spasms in your anus that do not stop.

SEEK CARE IMMEDIATELY IF:

• You have very bad pain in or around your anus.
  
  
• You have bleeding from your anus that does not stop.

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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