Anal Fissure

Anal fissure surgery treats a tear in the anal lining that has not healed with careful bowel care and prescribed creams. The usual operation releases part of the internal sphincter muscle so spasm eases and the tear can heal. Most suitable patients have this as a short day-case procedure under anesthesia.

A split in the lining, kept open by spasm

An anal fissure is a small tear in the anoderm, the sensitive lining of the anal canal. Most tears sit in the midline at the back. The pain is out of proportion to the size of the split, because that lining is richly supplied with nerves and because the internal sphincter beneath it goes into spasm. Spasm raises pressure, reduces blood flow to the tear, and stops healing. A hard stool reopens the split, and the cycle continues. Surgery exists for the fissure that has become chronic and has not healed when that cycle has been treated properly. It is not the first response to a week of painful bleeding.

The operation most often discussed is lateral internal sphincterotomy. In plain language, the surgeon makes a small cut at the side of the anal canal and divides a portion of the internal sphincter, the smooth muscle you cannot voluntarily relax. The aim is to lower the resting pressure so blood can reach the tear and the lining can close. The fissure itself is not always excised. Other operations, including a chemical relaxation with botulinum toxin or a tissue flap, are used when dividing muscle would threaten control of gas or stool. This page explains those choices at the level a patient needs for consent. It is not a set of instructions for performing the operation.

Dr. Mohammad Al-Zaitawi assesses anal fissures at his center in Amman, Jordan, as part of colorectal and proctology care. Many fissures never need an operation. The decision follows an examination, a history of what has already been tried, and an honest talk about continence. If pain is so severe that you cannot be examined awake, that examination can be done under anesthesia, and treatment can be completed in the same sitting when the diagnosis is clear.

What this page will not do

It will not give the strength of a cream, the number of units in an injection, or a diagram of how much muscle to cut. Those details are prescriptions and operative judgments. It will not promise that every fissure heals, and it will not publish a price. It will tell you how surgeons think about acute versus chronic tears, why the back of the anus is the usual site, when an off-midline tear needs a different diagnosis, and what recovery feels like. If you have fever, spreading redness, or pain with a swelling, you may have an abscess rather than a simple fissure. That needs prompt local care, not a planned flight.

An acute fissure is a recent tear that often heals with softer stools, warm baths, and a prescribed ointment. A chronic fissure has usually lasted beyond about six to eight weeks and may show a skin tag, a swollen papilla inside, or exposed sphincter fibers. Chronic tears are the ones most often considered for surgery.

How a short-lived tear becomes a chronic wound

The first episode is commonly a hard stool, a bout of diarrhea, or childbirth. Pain during the bowel movement and bright blood on the paper follow. If the stool is kept soft and the spasm is treated, many of these tears close over a few weeks. The lining is capable of healing when pressure falls and the split is not reopened every morning. Fiber, fluid, and time are treatments, not delays, in this early phase. A cream that relaxes the sphincter may be added. Pain relief matters, because fear of the next stool makes people hold on, which makes the next stool harder.

A fissure becomes chronic when that healing does not occur. The edges thicken. A sentinel skin tag may form at the outer end, like a small piece of extra skin that patients sometimes mistake for a hemorrhoid. Inside, a hypertrophied anal papilla may sit at the inner end. Between them, the base of the tear can show the pale transverse fibers of the internal sphincter. These features tell the clinician that the wound has stopped behaving like a simple cut. Ointment can still be worth a proper trial if it has never been used correctly, but the chance of lasting closure is lower than in the first weeks. The American Society of Colon and Rectal Surgeons guideline on anal fissures and ordinary clinical practice both treat this chronic picture as the setting in which surgery is discussed.

Why the back midline is special

The posterior midline has a relatively poor blood supply, which is one reason tears there persist. Anterior fissures, toward the front, are less common and are seen more often in women, including after childbirth. A tear that sits off to the side, or several tears at once, is a different message. It raises the possibility of Crohn's disease, a sexually transmitted infection, tuberculosis, HIV-related ulceration, or, rarely, cancer. Those conditions can look like an ordinary fissure and will not be cured by a standard sphincterotomy. They need the right examination, sometimes a biopsy, and treatment of the underlying disease. Do not assume that every painful split is the common kind because the pain feels the same.

A fissure can coexist with hemorrhoids, and the skin tag of a chronic fissure is often mislabeled as a pile. Treating the tag alone, or banding a hemorrhoid, does not release the spasm that keeps the tear open. Equally, not every episode of bright bleeding is a fissure. A change in bowel habit, dark blood, weight loss, anemia, or a family history of colorectal cancer needs an evaluation of the bowel above the anus, at an age and with a test matched to your risk. The fissure can still be treated. It should not be used as an explanation that closes the file on the rest of the colon.

The typical fissure causes sharp pain during a bowel movement and for minutes to hours afterwards, often with a small streak of bright blood. Itching and a skin tag may appear later. Severe pain that prevents sleep, a lump that is growing, or drainage of pus needs examination soon, because an abscess or a fistula may be present instead.

The story patients tell

People describe passing a stool as 'passing glass' or as a cut that then burns. They may avoid food, delay the toilet, or use a phone timer because they dread the next visit. A small amount of blood on the tissue is common. Heavy bleeding, clots, or blood mixed through the stool is not the usual fissure pattern and needs a broader look. Mucus and a sense of incomplete emptying can occur, but a new and persistent change in stool caliber should not be blamed on a fissure without thought. Pain that is only a mild itch, without a tearing sensation, is more often dermatitis, a hemorrhoid, or hygiene-related irritation.

Chronic pain changes behavior. People eat less fiber because they think food causes the pain, which hardens the stool and deepens the cycle. They may have already bought several creams. Bring the names of those creams to the visit so the surgeon can tell a real trial of sphincter-relaxing ointment from a barrier cream that never treated the spasm. A trial that was stopped after two days because of headache is different from a trial that lasted six to eight weeks. The headache, when it happens, is a known effect of nitrate ointments. It is a reason to change the prescription, not proof that every medicine will fail.

What the examination involves

A careful look with good light, the patient comfortable, often shows the tear. The clinician is gentle. A digital examination is useful when it is tolerable, because it assesses resting tone and looks for a tract or a mass, but it is cruel and unhelpful if pain makes you vault off the couch. In that case the right next step may be an examination under anesthesia rather than a forced inspection in clinic. Anoscopy, a short lighted look inside, is done when you can manage it. Proctoscopy and colonoscopy are chosen according to age, bleeding pattern, and risk. They are not a punishment and not a ritual for every twenty-year-old with a obvious posterior fissure and no other symptoms.

Tell the surgeon about childbirth, forceps or a tear at delivery, previous anal surgery, radiation, and any diagnosis of Crohn's disease or ulcerative colitis. Tell them if you leak gas or liquid or have to rush to the toilet. That history decides whether dividing sphincter muscle is wise. A fissure in someone who already has a weak sphincter is still painful and still deserves treatment. The treatment is more likely to be ointment, an injection that temporarily relaxes the muscle, or a flap that covers the tear without cutting the sphincter. Writing that history down before the visit keeps it from being forgotten in the embarrassment of the examination.

Most acute fissures, and a meaningful share of chronic ones, are treated without surgery. Soft stools, warm baths, and a proper course of sphincter-relaxing ointment are the usual first plan. Surgery is discussed when a chronic fissure remains after that care, or when pain is so severe that a trial is not realistic.

Bowel habit as treatment

The stool should be soft and formed, not liquid and not pellet-like. That usually means enough fluid and a soluble fiber supplement or food fiber that you actually tolerate. A huge sudden increase in fiber causes gas and can make you abandon the plan. A steady amount is better. Do not linger on the toilet, and do not strain to finish. A short walk after breakfast uses the natural reflex that moves the bowel. Constipating painkillers, especially opioid tablets, work against healing. If you need pain relief, ask for something that does not harden the stool, and use it so that fear does not make you postpone defecation. Warm baths, often called sitz baths, relax the pelvic floor and soothe the lining. They are not sterile rituals. Clean warm water, a few times a day and after stools, is enough. Soaps, scrubs, and antiseptics on the tear sting and do not speed closure.

Prescription ointments that relax the internal sphincter are widely used before any thought of an operation. Nitrate ointments and calcium-channel blocker ointments are the two families clinicians reach for. This page names them so you recognize the conversation. It does not state a percentage strength or a dosing schedule, because those are on your prescription and differ by product and by country. Use what was prescribed, for the length of time you were told, and report headache, rash, or dizziness rather than quietly stopping. A short, hesitant smear for three days is not a failed medical trial. Guidelines, including the ASCRS fissure guideline and NICE clinical knowledge guidance, support a genuine non-surgical attempt in the absence of features that demand a different diagnosis.

When medicine is no longer the whole plan

If a chronic fissure is unchanged after a proper trial, or if pain is preventing work and sleep now, sphincterotomy or an alternative procedure is a reasonable discussion. Some people are offered botulinum toxin injection as a middle step, particularly when cutting the sphincter is unattractive because of a previous obstetric injury, previous anal surgery, or existing leakage. The injection temporarily reduces spasm. Its effect fades over a few months. Healing may persist after the medicine has worn off, or the fissure may return, in which case a more definitive operation can still be considered. A comparison published in the New England Journal of Medicine helped establish injection as a real option rather than a curiosity. It is not a guarantee of permanent cure, and it is not 'weaker surgery.' It is a different balance of healing and continence risk.

Steroid creams used for weeks on the anus can thin the skin and are not a fissure treatment. Antibiotics do not close a routine fissure. Numbing gels can make a stool tolerable but do not reverse spasm. If you have been cycling through those products, bring them. The next step is a diagnosis and a timed plan, not another tube from a pharmacy shelf. Children and women late in pregnancy are usually managed without sphincter division. This guide is written for adults outside those situations. If you are pregnant, say so before any procedure is booked.

Lateral internal sphincterotomy releases part of the internal anal sphincter through a small cut at the side of the anus, away from the fissure in the usual technique. Resting pressure falls, blood flow improves, and the tear is then able to heal over the following weeks. It is the operation with the strongest record for chronic fissures that have failed other care.

What is being released, and why the side matters

You have two sphincter muscles. The external sphincter is the one you can squeeze. The internal sphincter is a ring of involuntary muscle that maintains resting tone. In a chronic fissure that tone is often too high for the lining to heal. Sphincterotomy divides a portion of the internal muscle only. It is done at the side, rather than by cutting straight through the painful tear at the back, because a midline cut backwards is more likely to create a groove that leaks. The side incision is small. Patients often expect a large wound and are surprised by the dressing. The fissure at the back is left to heal on its own in many operations. Sometimes a sentinel tag that bothers you is removed at the same time. Removing the tag is not the treatment. Releasing the spasm is.

This description is deliberately incomplete as a surgical manual. How much of the muscle is divided, whether the approach is open or closed, and how the wound is closed are decisions made in the operating room from your anatomy and your continence history. Cochrane reviews of operations for anal fissure have supported lateral internal sphincterotomy as effective treatment for chronic fissure. They have also recorded that a disturbance of continence can follow. The disturbance is usually to gas rather than to solid stool, and it is often mild, but it is not imaginary and it is not equally likely in every person. A woman with a sphincter already injured in childbirth does not have the same reserve as a young man with an intact ring. The operation is adjusted or declined accordingly.

What you should feel afterwards

The sharp tearing pain of the fissure usually eases as spasm drops, sometimes within days, even before the lining has fully closed. A dull ache at the side incision and a small streak of blood with stools can continue for a week or two. Healing of the skin is judged over several weeks, not on the morning after surgery. You will be asked to keep the stool soft throughout, because a hard stool can reopen a fissure that was on its way to closing. The operation does not make fiber optional. It makes fiber more likely to succeed.

Most people have this as a day case. You walk out the same day once you have passed urine and the team is content. A companion should take you home if you have had sedation or general anesthesia. The result you are hoping for is a closed fissure and a bowel movement you no longer fear. The result you are accepting as a risk is a slightly looser control of wind. Those two sentences are the heart of informed consent for this operation. If they have not been said to you in clinic, they should be said before you sign.

When dividing the sphincter is a poor trade, other concepts are used. Botulinum toxin relaxes the muscle for a limited time. Fissurectomy removes the chronic edges of the tear. An advancement flap covers the wound with healthy tissue. These are choices for particular anatomy, not a menu of upgrades.

Botulinum toxin

Botulinum toxin is injected into the internal sphincter so that spasm eases without a permanent cut. The injection is done in clinic or under a short anesthetic if examination is otherwise impossible. You will not be given a unit count on this page, and you should not seek a cosmetic dose from a non-surgical setting. The medicine used for a fissure is a prescribed treatment with a continence discussion attached. Over the following days the muscle relaxes. Pain may improve before the tear looks healed. The effect wears off over a few months. During that window many fissures close and stay closed. Some reopen, and a repeat injection or a later sphincterotomy can be discussed. Temporary leakage of gas or of a small smear of stool can occur while the muscle is weak. That risk is a reason the option exists for people who cannot afford a permanent cut, and it is also a reason it is not casual.

Injection does not treat an abscess, a fistula, or Crohn's disease. If the 'fissure' is actually an ulcer of another cause, relaxing the sphincter will disappoint you. This is why the examination comes first. People who have already had a sphincterotomy and still have pain need a new diagnosis, not an automatic second cut. A residual fissure, a fistula, or a pelvic floor problem that has nothing to do with the original tear can all feel similar from the inside.

Fissurectomy and flaps

Fissurectomy means removing the chronic, rolled edges of the tear and sometimes the sentinel tag, so a fresh wound remains that can heal. On its own, in a sphincter that is still in tight spasm, it may not be enough, which is why it is sometimes paired with an injection that relaxes the muscle. An advancement flap takes a small paddle of healthy skin or anoderm and moves it over the defect so the base of the fissure is covered and the sphincter is left intact. The concept is coverage and blood supply, not muscle division. Flaps are particularly considered when continence reserve is limited: previous obstetric injury, previous sphincter surgery, or a fissure in a low-pressure anus that is failing to heal for a reason other than spasm. A low-pressure fissure is important to recognize. Cutting more muscle in a sphincter that is already weak is how continence is made worse without helping the tear.

None of these operations is 'laser fissure surgery' by another name. Energy devices are instruments, not a different disease strategy. If a clinic sells a laser as painless and risk-free, ask what is actually being done to the muscle and what the continence counseling is. The biology does not change because the tool is modern. Dr. Al-Zaitawi will recommend the procedure that matches the fissure in front of him, including the recommendation to continue non-surgical care when that is the safer healing path. A request for a particular gadget is not an indication.

Sphincterotomy suits adults with a chronic fissure, high sphincter tone, and intact continence, after a real trial of non-surgical care or when pain makes that trial impossible. Extra caution, and often a different operation, applies when the sphincter is already damaged, the fissure is off the midline, or inflammatory bowel disease is active.

A reasonable candidate

You are in the group usually offered lateral internal sphincterotomy if examination shows a chronic posterior or anterior midline fissure, you are not leaking, you have not had a sphincter injury, and ointment or an equivalent plan has failed or cannot be tolerated. You understand that a small risk of weaker gas control exists, and you prefer a definitive release of spasm to a temporary injection. You can keep the stool soft afterwards. You are not pregnant. Your bleeding pattern does not suggest an uninvestigated bowel cancer. Those are clinical judgments made in the room, with the examination, not boxes you tick on a form.

Severe pain with a obvious fissure and an inability to work can justify moving to surgery earlier than a full eight-week ointment trial. That is mercy, not a shortcut past the diagnosis. The examination still has to show a fissure rather than an abscess, a thrombosed hemorrhoid, or a fistula. If you have flown to Amman with a photograph and no examination, the first act is still to look. Some people are treated on the day of examination under anesthesia because they could not be examined awake. Consent for that pathway should name the procedures that might be performed once the diagnosis is seen, including the possibility that no sphincter is cut if the findings are unexpected.

Situations that change or postpone surgery

Previous childbirth injury, prior fistula or hemorrhoid surgery that divided sphincter, radiation, and any current leakage push the plan toward ointment, botulinum toxin, or a flap. An off-midline or multiple fissures need thought about Crohn's disease and infection before anyone relaxes or cuts muscle. Active perianal Crohn's disease is treated with the gastroenterologist. An operation aimed only at a 'ordinary fissure' can create a wound that does not heal. HIV and other infections are not reasons to refuse care. They are reasons to know the diagnosis and to involve the right treatment. A patient on blood thinners can still have surgery once the prescribing doctor has agreed a plan. Stopping a heart medicine without that conversation is more dangerous than a fissure.

Anal pain from levator spasm, from a pelvic floor that cannot relax, or from a chronic pain syndrome can be misread as a fissure, especially if a tiny split is also present. Cutting the sphincter does not treat muscle incoordination higher in the pelvis. If the examination does not show a clear chronic fissure, the honest plan may be bowel care, physiotherapy, or a second opinion rather than an operation you have already mentally scheduled. International patients sometimes arrive expecting a date the next morning. The center would rather postpone than divide the wrong muscle. That is the standard you should want.

Preparation is simpler than for major abdominal surgery and still specific. The surgeon needs your continence history, your medicines, and a clear agreement on which procedure will be done. You need a soft stool plan, a companion for the journey home, and time off heavy work.

The conversation before the day

Consent for sphincterotomy covers the aim, the small side incision, the possibility of removing a skin tag, the alternatives of continued ointment or injection, and the risks: bleeding, infection, a fissure that does not heal, and a change in control of gas or, less often, stool. Consent for an injection or a flap names those procedures instead, so you are not surprised by the wound you see. Ask what will happen if the examination under anesthesia shows a fistula rather than a fissure. The operations are different, and the continence stakes of fistula surgery are different again. A plan that says 'we will treat whatever we find' should still list the likely options in language you understand.

Bring a list of blood thinners, including aspirin and supplements that affect clotting, diabetes medicines, and the ointments you have already used. Do not stop a prescribed anticoagulant because a friend did. The team will time the last dose with the doctor who manages your heart or your clots. If you could be pregnant, the test happens before any anesthetic. If you have Crohn's disease, the gastroenterology plan should be known. Fasting follows the anesthetic instruction, commonly no solid food for about six hours and clear fluids stopped later, unless you are having a purely local procedure with different rules. You will be told which applies to you. A full bowel cleanse is not routine for fissure surgery. A small enema is sometimes used. Do not invent a harsh laxative the night before.

Practical arrangements in Amman or at home

Eat a normal diet with your usual fiber until the fasting window. Buy the fiber you will use afterwards so the first two days are not a search for a pharmacy while you are sore. Arrange a soft seat for the car and loose underwear. Plan not to drive yourself if you will be sedated. Desk work may resume within a few days for many people. Leave a margin anyway. Physical jobs need longer, often one to two weeks, depending on pain and on whether the wound is a tiny side incision or a flap that must be protected. If you are traveling to Amman, do not book the return flight for the same evening. A review the next day, or a clear remote check with instructions, is part of a safe short stay. The fee is quoted after the procedure is chosen, because an injection, a sphincterotomy, and a flap are not the same hospital event. This page does not list a number.

Shower on the morning of surgery. You do not need to shave the area yourself. Skin nicks from a razor are an infection risk the hospital would rather avoid. Write your questions: how soon to bathe, whether stitches dissolve, when bleeding should worry you, and who answers the phone over the weekend. If colonoscopy has been recommended because of your age or your bleeding, ask whether it should happen before or after the fissure is treated. Sometimes the fissure pain makes a bowel preparation intolerable, and the colonoscopy is scheduled once healing has started. Sometimes the colonoscopy comes first because the result could change everything. There is no universal order. There is a reason in your case, and you should hear it.

Fissure surgery is typically a short day-case operation. You are anesthetized or carefully numbed, the surgeon confirms the diagnosis, performs the agreed procedure, and you recover until you can walk and pass urine. Most people go home the same day with written advice on baths, stool softness, and warning signs.

From admission to the operating room

You are admitted to the day unit, identity is checked, and the consent is confirmed. The anesthesiologist reviews allergies, reflux, sleep apnea, and previous anesthetics. Many fissure operations are done under general anesthesia or under spinal anesthesia. Some are done with local anesthetic and sedation. The choice depends on the procedure, on whether a full examination is needed because pain blocked it in clinic, and on your health. You will not be asked to watch. You will be positioned so the surgeon can see the anal canal clearly. Dignity is maintained with drapes and a chaperone culture that should feel routine, not exceptional. If you want a staff member of a particular gender present, say so early. Hospitals can often accommodate that request and should not be surprised by it.

Once you are comfortable and anesthetized or numbed, the surgeon inspects the fissure, feels the tone, and looks for a tract that would mean a fistula. Only then is the planned release, injection, or flap carried out. If the findings differ from the clinic impression, the operation follows the consent you gave for that possibility, or it stops and wakes you for a new discussion if the finding is something you did not agree to treat. A straightforward sphincterotomy does not take long. A flap takes longer because tissue is moved and sutured. You will not be given a minute-count as a promise. Short is not a synonym for careful, but this is not a major abdominal operation, and the recovery reflects that.

Waking up and going home

A dressing or a small pack may be in place. A feeling of fullness and a desire to pass a stool is common and usually settles as the pack is removed or works its way out according to instruction. Do not pull at anything you were told to leave. Passing urine before discharge matters, especially after spinal anesthesia, because temporary difficulty voiding is a known early nuisance. Pain is expected to be less than the fissure pain you came with, although the side wound aches. You are discharged with pain medicine that, as far as possible, does not constipate, a plan for baths, and the number to call. You need a responsible adult if you have had sedation or general anesthesia. The first meal at home should be ordinary and not a test of a huge fiber load.

Look at the written instruction before you leave the building, while someone can still explain it. Know whether you may shower that night, whether a bath starts the next morning, and what 'a little blood' means versus 'bleeding that does not stop.' A spoonful of bright blood with the first stool can be normal. A bowl of blood, dizziness, or bleeding that soaks dressings repeatedly is not. Fever is not normal. Neither is pain that climbs day after day instead of easing. Those distinctions are the useful content of a discharge conversation. A generic leaflet that only says 'rest' is not enough, and you should ask for the gaps to be filled before you travel back to a hotel.

After fissure surgery the spasm often relaxes before the skin has fully healed. Keep stools soft, use warm water, and expect a small amount of blood for a short time. Many people return to desk work within a few days to a week. The fissure is judged healed over several weeks, not on the first morning.

The first bowel movements

The first stool is the moment people dread, and it is usually kinder than the stools that brought them to surgery, provided it is soft. Take the fiber and any gentle laxative you were given before you are in trouble, not after two days of holding on. Drink enough that the urine is pale. A sitz bath after the stool relaxes the muscle and cleans the area without wiping it raw. Pat dry. A soft unscented barrier if it was suggested can protect the skin. Avoid wet wipes with perfume, and avoid a bidet on a harsh setting aimed directly at a fresh wound. Sitting in warm water is the gentler cleaner.

A streak of blood on the paper can continue intermittently while the fissure closes. Pain should become a dull tenderness rather than the old tearing. If the old pain is identical after two weeks, do not conclude that surgery failed, and do not conclude that it succeeded. You need a look. Some wounds heal from the edges over three to six weeks. Flaps need protection from tension and from a hard stool for a similar period, sometimes longer. Stitches in a flap are often dissolving. Do not search for them. A skin tag that was left behind on purpose, because it was not part of the problem, will still be there. Its presence is not a failed operation.

Work, sport, and travel

Walking is encouraged immediately. It reduces stiffness and does not burst a sphincterotomy. Sitting for long meetings may need a soft cushion for a few days. Driving is reasonable when you are not sedated and you can move your foot quickly without a stab of pain. Gym work on the lower body, cycling, and heavy lifting wait until sitting and straining are comfortable, often around two weeks for a simple sphincterotomy and longer for a flap. Swimming waits until the skin has closed and your surgeon agrees, because a public pool is a poor place for an open wound. Sexual activity that puts pressure on the anus waits for comfort and for clearance. There is no prize for testing the wound early.

Flying after a day-case fissure operation is often possible within a few days if pain is controlled, you are passing urine, and there is no fever or heavy bleeding. A same-night long-haul flight is still unwise. You cannot easily manage a bleed or urinary retention in a cabin, and you should not be making that decision while the anesthetic is wearing off. If you came to Amman for the operation, build in a buffer of several days. Remote follow-up works well when healing is straightforward: you report pain, bleeding, and continence of gas and stool at an agreed interval. If control of stool is worse than you were led to expect, that report should be early, not saved for a six-week courtesy call. Most such changes are minor and improve. The ones that need help are exactly the ones people are embarrassed to mention.

Bleeding, infection, a fissure that fails to heal, and a change in continence are the risks to weigh against the pain you already have. For a well chosen sphincterotomy, healing is the usual outcome and a lasting loss of solid-stool control is uncommon. The risk is higher if the sphincter was already injured. That is why selection is the real safety step.

Continence, stated plainly

The internal sphincter contributes to resting pressure, which is part of how you keep gas in and how you keep a small smear of liquid from escaping when you are tired. Dividing a portion of it can make wind harder to hold, especially when you bend or when stool is loose. Soiling of underwear can occur in a smaller group. Frank incontinence of solid stool is not the expected result of a limited lateral sphincterotomy in a person with a healthy sphincter, but it is a catastrophe when it happens, and it is more plausible if too much muscle is cut or if the external sphincter or a previous obstetric injury was underestimated. This is why the operation is conservative, why the side is chosen rather than the back midline, and why some patients are steered toward injection or a flap. You should be asked about leakage before surgery. If you were not asked, volunteer it.

Published reviews, including Cochrane reviews of fissure operations, describe high healing after sphincterotomy and a measurable rate of continence disturbance that varies with how strictly studies defined it. A study that counts every episode of lost wind will report a higher figure than a study that counts only people who wear a pad. Quoting one percentage as your personal risk would be false precision. What you can take from the literature, and from the ASCRS guideline, is the shape of the trade: surgery heals chronic fissures more reliably than ointment in many trials, and the price is a continence risk that is usually small and sometimes not. People who already leak are the ones for whom that price is too high.

Other complications

Bleeding is usually a streak. A vessel that does not stop needs pressure and a return to the hospital, occasionally a short second procedure. Infection is uncommon in a clean day-case wound and more likely if a hematoma or a retained pack is ignored. An abscess after fissure surgery is not a normal ache. Fever and throbbing pain need a same-day examination. Urinary retention, the inability to pass urine, is an early problem, more often in men and after spinal anesthesia. It is treated. It is not a reason to drink nothing in the hope of avoiding the toilet. A fissure that does not heal may mean the spasm was not adequately released, the stool stayed hard, or the diagnosis was wrong. A second operation is sometimes needed. It is planned after an examination, not booked automatically, because a second cut in a non-healing wound without a new diagnosis is how continence is damaged.

A flap can fail to take, leaving a wound that heals more slowly but usually still closes with care. Injection can cause temporary leakage and can fail, returning you to the original choice. None of these events is a reason to avoid a necessary operation if pain is wrecking your life and the sphincter can afford the chosen procedure. They are a reason to match the procedure to the sphincter you have. Allergic reactions to anesthetics and to antibiotics, when antibiotics are used, are rare and are the reason the team asks about allergies twice. Clots are very uncommon after such a short operation, but they are not impossible in a person who flies dehydrated the same day. That is another argument for a buffer before travel, not a reason to fear a day-case procedure that you actually need.

Dr. Mohammad Al-Zaitawi assesses and treats chronic anal fissures in Amman, Jordan, including day-case surgery when an operation is the right next step. Non-surgical care is used first when it is likely to heal the tear. The fee is set after the procedure is chosen, and no result is guaranteed.

What the visit is for

Dr. Al-Zaitawi holds the Jordanian Board in General Surgery and is a Fellow of the American College of Surgeons and a Fellow of the International College of Surgeons. Proctology, including fissure, fistula, and related anal conditions, is part of the colorectal work of the center. At a fissure consultation you should expect a history of pain, bleeding, childbirth, and prior surgery, a continence question asked without embarrassment, and an examination that stops if it is causing harm. If a chronic fissure is confirmed and medical care has already failed, the options are explained in the terms used on this page: sphincterotomy, injection, or a flap, with a recommendation rather than a catalogue. If the fissure is acute, you may leave with a bowel plan and a prescription instead of a date for theater. That is a successful consultation.

Local patients and patients traveling to Jordan follow the same clinical threshold. The traveler's extra task is logistical. Send a description of symptoms and any prior examination findings before you fly, so you are not crossing a border for a problem that still needs eight weeks of ointment at home. If you do come for surgery, stay long enough for the anesthetic to wear off and for bleeding or difficulty passing urine to declare themselves before you are in the air. The English consultation route on jordansleeve.com is the right channel for records. It is not an emergency line. A painful swelling, fever, or uncontrolled bleeding belongs in an emergency department where you are.

Fees, follow-up, and the limit of a webpage

Cost depends on whether you need an examination under anesthesia, an injection, a sphincterotomy, or a flap, and on the hospital and the anesthetic. A written quote follows that decision. It is not a package that promises healing for a fixed sum, and an unexpected finding, such as a fistula, can change the operation and the fee. Ask what is included: the hospital, the follow-up visit, and care if a bleed brings you back the same week. Those items matter more than a low headline number from an advertisement this site does not run.

Follow-up checks pain, bleeding, healing of the fissure, and continence. Say if wind is harder to hold. Early reassurance is appropriate when the change is mild and improving. Early assessment is appropriate when stool is escaping. You do not need to produce a cheerful review of your experience, and this page does not invent one. Published healing after properly selected sphincterotomy is good. Your healing is an individual event that the clinic should actually look at.

This guide is general education. It does not diagnose your pain, prescribe an ointment strength, or describe how to perform sphincterotomy. Chronic anal pain deserves an examination by someone who treats fissures regularly. If that is your situation, you can request a consultation with Dr. Mohammad Al-Zaitawi in Amman and bring your continence history with you. If you are acutely unwell with a swelling or fever, seek urgent care first. Surgery is for the fissure that has earned it, after the alternatives have been respected.