Fissure-in-ano

• Authorization should be obtained prior to surgery and will be done by the hospital or the rooms staff depending on whether you are an in- or outpatient.

• Make sure that you have been fasting for solid foods for at least 6 hours prior to your surgery and for clear liquids or water for at least 2 hours prior to your surgery. Discuss your chronic medications with your doctor or hospital staff prior to your surgery as you usually are allowed to take chronic medications the day of surgery, barring diabetic medication the day of the procedure. If you are taking any blood thinning medication please discuss these in detail with your doctor as special arrangements need to be made for these.

You will be admitted to hospital or day theatre. The procedure is usually performed under general or spinal anaesthesia. After the procedure, you will be monitored in recovery and discharged once stable.

Initial treatment usually includes stool softeners, fibre, fluids, topical medication, pain control, and warm sitz baths.  For unexplained rectal bleeding colonoscopy would be advised.

If surgery is required, the procedure may involve a Lord's procedure (dilatation) or lateral internal sphincterotomy, where a small portion of the internal anal sphincter is divided to reduce pressure and allow the fissure to heal. In selected cases, associated skin tags or chronic scar tissue may also be removed.

The procedure usually takes 15–30 minutes.

• Possible complications include bleeding, infection, pain, delayed healing, recurrence of the fissure, temporary or rarely permanent difficulty controlling gas or stool, and unintended damage to surrounding structures.

• 1 day