A sphincterotomy is a specialized surgical procedure that involves making a small, controlled incision in a portion of the internal anal sphincter muscle. At our practice, we understand that anal fissures can cause excruciating pain and significant impact on quality of life. That's why we're committed to providing compassionate, expert care while helping you understand each step of your medical care.
This targeted procedure effectively treats chronic anal fissures—painful tears in the lining of the anal canal—that have not responded to conservative measures including dietary changes, topical medications, and lifestyle modifications. Our sphincterotomy approach utilizes precise surgical techniques to release just enough sphincter tension to promote healing while carefully preserving continence. We employ either open or closed techniques based on your specific anatomy and condition, strategically placing the incision to maximize effectiveness while minimizing complications. Our comprehensive approach includes both pre-operative optimization and detailed post-operative care, resulting in high success rates and rapid pain relief for this debilitating condition while preserving normal bowel function for long-term quality of life.
You may need a sphincterotomy for anal fissure if you experience:
Severe pain during or after bowel movements that lasts for hours
Bright red bleeding with bowel movements, typically visible on toilet paper
Persistent anal fissure despite 6-8 weeks of conservative treatment
Visible tear or crack in the anal canal identified during examination
Sentinel tag (small skin tag) at the external end of the fissure
Hypertrophied anal papilla at the internal end of the fissure
Anal spasm or tightness detected during examination
Fear of bowel movements due to anticipated pain
Constipation resulting from pain avoidance
Recurrent anal fissures following periods of healing
Significant lifestyle limitation due to fissure symptoms
Secondary issues including urinary retention from pain
Multiple fissures or unusual location suggesting inflammatory bowel disease
Chronic constipation contributing to fissure development
Psychological distress from persistent, significant anal pain
In our practice, our approach to anal fissure treatment combines precision with personalized care. Our treatment strategy follows a stepwise progression, beginning with comprehensive conservative measures before considering surgical intervention. What defines us is our surgeon’s expertise in determining exactly when surgery will provide the most benefit, neither rushing to operate before non-surgical options have been adequately explored nor delaying effective surgical relief when conservative treatment has failed.
For initial management, we prescribe a regimen including fiber supplementation, adequate hydration, sitz baths, and topical treatments such as nitroglycerin or calcium channel blockers to relax the internal sphincter non-surgically. When these measures are insufficient, we may recommend targeted botulinum toxin injection into the internal sphincter, providing temporary relaxation that allows healing in approximately 60-80% of patients without permanent sphincter alteration.
When surgical intervention becomes necessary, our sphincterotomy technique focuses on precision and sphincter preservation. We perform lateral internal sphincterotomy, making a small incision either at the fissure site (direct approach) or away from it (indirect approach) based on your specific anatomy and fissure characteristics.
Our surgeons employ either:
Open Sphincterotomy: A small incision at the anal margin allows direct visualization of the internal sphincter for precise, controlled division of just enough muscle to release tension while preserving function.
Closed Sphincterotomy: Using a more minimal approach, a narrow blade is inserted beneath the mucosa to divide the internal sphincter without an external incision, offering slightly faster healing for appropriate candidates.
In both techniques, we divide approximately 30-40% of the internal sphincter fibers—enough to reduce pressure and allow fissure healing, but carefully limited to maintain continence. Throughout your medical care, we provide comprehensive education about post-procedure expectations and detailed instructions for optimal healing. Our multidisciplinary approach addresses underlying contributors to fissure development, such as dietary habits or underlying conditions, ensuring not only resolution of your current fissure but also minimized recurrence risk for long-term relief.
Immediate Post-Procedure (1-3 days)
Experience significant pain relief, often immediately after the procedure
Receive appropriate pain management, though requirements are typically minimal compared to pre-operative pain
Begin sitz baths (warm water soaks) within 24 hours, continuing 2-3 times daily
Take stool softeners and fiber supplements as prescribed to prevent constipation
Expect minimal bleeding or drainage from the surgical site
Maintain gentle cleansing after bowel movements
Monitor for urinary retention, which can occasionally occur
Understand that your first bowel movement may cause apprehension but is rarely as painful as pre-operative movements
Apply prescribed topical treatments as directed
Use cold packs intermittently for comfort during the first 24-48 hours
Resume a light diet initially, advancing to high-fiber foods as tolerated
Continue pain medication as needed, though many patients require minimal analgesia
Short-Term Recovery (1-2 weeks)
Attend your follow-up appointment (typically 1-2 weeks after surgery)
Continue sitz baths after bowel movements and 2-3 times daily
Maintain a high-fiber diet and adequate fluid intake
Avoid heavy lifting (nothing over 10 pounds) for 1-2 weeks
Monitor for proper healing and report any concerns
Experience continued improvement in pain with bowel movements
Expect some mild discomfort or pressure in the anal region
Resume most normal activities within 3-7 days
Return to work based on your surgeon's recommendation and job requirements (typically 2-7 days)
Avoid prolonged sitting if it causes discomfort
Begin to notice healing of the fissure as sphincter pressure has been reduced
Use mild pain relievers as needed, though many patients require none by this stage
Maintain good perianal hygiene without excessive wiping or scrubbing
Long-Term Recovery (3-8 weeks)
Notice complete healing of the fissure, typically within 6-8 weeks
Experience continued absence of pain with bowel movements
Resume all normal activities without restrictions
Maintain dietary habits that promote soft, regular bowel movements
Monitor for any signs of recurrence or new fissure development
Evaluate any changes in bowel control, which are typically minimal to none
Follow recommendations for ongoing prevention:
Adequate fiber (25-30g daily)
Sufficient water intake
Regular exercise
Prompt attention to constipation
Observe complete resolution of bleeding with bowel movements
Recognize normal bowel function without pain or fear
Address any concerns about minor changes in sensation or function with your healthcare team
Expect the surgical site to be well-healed with minimal visible evidence of the procedure
Long-Term Expectations
Success rates of 90-95% for permanent healing of chronic anal fissures
Low recurrence rates (5-10%) when preventive measures are maintained
Preservation of normal bowel control in over 95% of patients
Complete relief from the cycle of pain, spasms, and poor healing
Minor, temporary changes in control of gas in some patients (typically resolves within 1-3 months)
Rare cases of minor incontinence to liquid stool (1-3% of patients)
Normal sexual function and lifestyle without restrictions
Continued attention to bowel habits remains important for prevention
Regular follow-up during the first year to confirm sustained healing
Excellent long-term outcomes and quality of life improvement
Simple measures are typically effective if early signs of recurrence appear
Ability to prevent future fissures through identified lifestyle modifications
Normal anal canal appearance on subsequent examinations
Lifelong relief for most patients following successful healing
Common Side Effects
Mild discomfort at the surgical site for a few days
Minor bleeding during the first few bowel movements
Temporary anal seepage or mild discharge during initial healing
Brief episodes of minor gas incontinence, typically resolving within weeks
Mild bruising around the surgical area
Temporary swelling around the anal region
Sensation of anal pressure or awareness
Minor itching during the healing process
Temporary increased moisture in the perianal area
Heightened awareness of the need to defecate
Less Common Complications
Infection of the surgical site (rare with proper care)
Delayed healing requiring additional management
Persistent or recurrent fissure despite surgery (5-10%)
Fecal incontinence (rare, affecting 1-3% of patients):
Usually minor and limited to gas or liquid stool
Typically temporary but occasionally permanent
More common in women after childbirth, elderly patients, or those with pre-existing sphincter weakness
Formation of a small skin tag at the surgical site
Anal stenosis (narrowing) from excessive scarring
Bleeding requiring intervention beyond simple pressure
Development of an anal abscess or fistula
Urinary retention requiring temporary catheterization
Persistent pain not related to the original fissure
When to Seek Immediate Medical Attention
Excessive bleeding (more than a few tablespoons)
Severe, increasing pain not controlled by prescribed medications
Fever over 101°F (38.3°C)
Inability to urinate for more than 6-8 hours
Significant swelling, redness, or purulent drainage from the surgical site
New onset of significant fecal incontinence
Severe constipation or inability to pass stool for more than 3 days
Persistent nausea or vomiting
Increasing rather than decreasing pain after the first 48 hours
Unusual odor from the surgical site
Significant change in the appearance of the surgical area
Development of new, severe rectal pain different from the original fissure pain
Signs of systemic infection including chills or confusion
From your first consultation through your complete recovery, we provide:
Thorough evaluation and explanation of your condition
Clear discussion of all treatment options, including non-surgical alternatives when appropriate
Detailed pre-operative instructions to help you prepare
Compassionate care during your hospital stay or outpatient procedure
Comprehensive follow-up care and support during recovery
Ongoing availability to address questions or concerns
We understand that facing head and neck surgery can be intimidating, but you don't have to navigate this journey alone. Our team is committed to providing expert care with a personal touch, ensuring you feel supported, informed, and confident every step of the way.
Your health and wellbeing are our highest priorities, and we're honored to be part of your care team.
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All our laparoscopic procedures are performed by our highly trained surgical team using state-of-the-art equipment and techniques.
We're committed to providing you with the most advanced, minimally invasive options because we believe you deserve:
Less pain after surgery
Shorter hospital stays
Faster return to work and activities you enjoy
Smaller, less visible scars
Lower risk of complications
Better overall outcomes
Dr. Richard Nguyen is a board-certified General Surgeon with over 20 years of surgical expertise and fellowship training in Minimally Invasive and Bariatric Surgery from Vanderbilt University. Since establishing his practice in San Jose in 2007, he has pioneered innovative surgical techniques, including single-incision laparoscopic procedures and mastery of the da Vinci Robotic Surgical System. Beyond his acclaimed bariatric surgery practice, he has earned national recognition for his specialized expertise in both non-mesh and advanced mesh hernia repairs, while also serving as a critical approach surgeon for anterior spine access procedures. Dr. Nguyen combines technical precision with personalized care across multiple premier facilities throughout the South Bay Area.
I would refer Doctor Nguyen to anyone, in fact I have and they have all had the same experience as me. He is truly great. I owe all my success to Doctor Nguyen and I thank him for all the work he has done for me and continues to do so. He is extremely amazing, and I am very grateful to him.
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At 50, I now have a life I had only dreamed of a year before. My body tells me if I am done eating. This surgery is a tool that I have used to the fullest. It is not an easy way out. It still took work. But I honestly know that I would not be living this amazing new life if I didn’t step forward to embrace this life-saving surgery.
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Dr. Nguyen has changed my life completely. I feel so much better and I also feel like I’ve got control of my life again…I had high blood pressure, diabetes and cholesterol. I took at least 5 different medications for the past 30 years. NOW, after surgery I take no medications only vitamins!
Wondering which surgical procedure might be right for your condition? We're here to help you understand your treatment options and develop a personalized surgical plan. Contact our office today to schedule a consultation.
Your path to improved health may be more achievable than you think—with advanced surgical techniques leading to faster recovery, reduced complications, and a significantly enhanced quality of life.