Anal Fissure Surgery

Case Study:

“Four months ago, my partner and I were engaging in anal intercourse with me on the receiving end. Typically, I’m more top/verse so with him being rather girthy, we embarked on an amazing session… until it wasn’t. At some point after him entering me from behind, I don’t know if it was our position or because he was not lubricated enough, but I felt an extremely painful tearing that was accompanied with bright red blood. Of course we stopped right away and I tended to it for a few weeks with some creams. However, I haven’t really felt normal since then and have had on and off issues with pain and spotting during bowel movements. Without question, this has limited my bottoming experience — i.e. no bottoming at all. I have become so frustrated and finally did some investigating on seeking advice for corrective action. Sex is so integral to our relationship and because of this, we both have felt the strain.”

What is an anal fissure?

An anal fissure is a small tear in the lining of the anal canal. This tear, which may develop from passing hard stools and/or the trauma associated with anal intercourse, may be associated with pain, discharge, bleeding, or the development of a localized skin tag. Acute fissures can heal without anal fissure surgery with an appropriate bowel regimen, as well as with the use of topical creams, suppositories, and refraining from intercourse. However, most anal fissures that become chronic and nonhealing will require surgical intervention.

What are the symptoms of an anal fissure?

Symptoms vary from bleeding, discharge, pain, and/or the development of a localized skin tag. Since the tear is overlying exposed muscle, you may also develop sphincter spasms. Anal intercourse in and of itself can be quite painful, with bleeding limiting one’s engagement.

How are anal fissures diagnosed?

Most anal fissures can be diagnosed by visual inspection. While anoscopy is the preferred method, since it allows for a thorough evaluation, pain is the limiting factor and this exam may be deferred until it has had sufficient time to heal or placed under anesthesia.

How are anal fissures treated at Bespoke Surgical?

The appropriate initial regimen to treat an anal fissure consists of:

  • Over-the-counter stool softeners, such as Colace, three times daily
  • Over-the-counter fiber supplements, such as Metamucil
  • Calmol 4 suppositories twice a day, found at small local pharmacies such as C.O. Bigelow, New London Pharmacy, or Capsule Pharmacy.
  • Sitz baths, utilizing over-the-counter epsom salts
  • A small pea-size drop of Lidocaine 2%/Anusol 2.5%/Cardizem 2% topical anal ointment should be gently applied by fingertip to the anal opening before bed, in the morning, and after each bowel movement. This compound can be obtained solely by prescription at Capsule Pharmacy in NY.
  • Boosting your fiber intake with choices such as grains and whole-grain products, fruits, vegetables, legumes, nuts, and seeds
  • Increasing your overall water intake to 8-12 ten ounce glasses per day
  • Refraining from caffeinated beverages, as they tend to cause dehydration
  • Keeping the anal area clean and dry. Wash gently with warm soapy water, and hairblow dry.
  • Limiting the use of toilet paper, as wiping causes local inflammation. Please refrain from using baby wipes or medicated pads since this prevents healing from its harmful chemicals.
  • Anal pathology takes time to heal. You can imagine that every time it is attempting to improve, another local trauma/bowel movement occurs. Do not try to avoid having bowel movements, and try not to get frustrated as you work on the above regimen.

Anal Fissure Surgical Treatment

The most commonly used surgery is a fissurectomy, in which the chronic scar tissue and skin tag is completely excised or cauterized to encourage closure. This allows for new healthy tissue to form, while using the above medical management. A lateral internal sphincterotomy is not advised in clients who engage in anal intercourse, as this procedure can cause future complications limiting sex, as well as incontinence. In the anal intercourse world, most fissures are more from trauma related injuries, then actual muscular tightness. During the procedure the muscle is dilated with surgical dilators and depending on the clients, botox is used to improve healing. Botulinum is injected into both the fissure line, as well as the internal sphincter to allow for just enough relaxation during the healing process. This will also help post anal fissure surgery, making sure this relaxation is utilized to our advantage when you start dilating with butt plugs post-surgery; all in the hopes of returning to anal engagement if one desires.

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Dr. Evan Goldstein, D.O.

Dr. Evan Goldstein, D.O.

Dr. Evan Goldstein is the founder and President of Bespoke Surgical, a surgical practice for modern males based in New York and Los Angeles. He received his medical doctorate from the University of Medicine and Dentistry School of Osteopathic Medicine in 2002. Receiving the highest osteopathic education was pivotal in shaping his holistic whole-life approach towards his practice of private surgical care.

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