What is Sphincterotomy?


Sphincterotomy is a surgical procedure to cut or stretch sphincter. Sphincter is the circular muscles around the anus that control bowel movement (BM).

Sphincterotomy is a treatment for patients that suffers from anal fissures, piles or sometimes described as passing of glass. The purpose of sphincterotomy is to loosen the sphincter muscles and facilitate healing.

The procedure or operation is not to be confused with fistulotomy. Fistulotomy is a surgical operation on fistula, an abnormal growth in various tracts in the body organ. However, it is common to have both sphincterotomy and fistulotomy performed in the same operation.

There are 2 types of sphincterotomy :

  1. Lateral Internal Sphincterotomy (LIS) – This the only type of sphincterotomy used to treat anal fissure.
  2. Endoscopy Sphincterotomy (EST) – This is a type of surgery using endoscope to remove gallstones from bile (not a treatment for anal fissure)

Sphincterotomy is not the only treatment available for anal fissures. Below are some other common treatments, usually for less serious cases of anal fissure :

  • High fibre diet
  • Stool softneners
  • Botox

Botox (botulinum toxin) treatment is also known as chemical sphincterotomy. It is performed by injecting Botox into the internal sphincter. It involves no surgical procedure.

In many anal fissure cases, sphincterotomy usually is the final solution suggested when all other treatments failed.

Sphincterotomy Medication and Supplements

Many who suffers from anal fissure can agree that medication and supplements have helped them in managing the problem. In fact, medication is one important aspect for pre-sphincterotomy and post-sphincterotomy care.

Below is a list of medication and supplements for sphincterotomy. Some of them are quite common, while others are based on tried-and-tested recommendations by patients.

Note : This is not a prescription. You should consult your doctor for your sphincterotomy medication based on your medical condition and history.

  • Miralax
    A stool softener, available mostly in US. Where to buy?
  • Lactulose
    A stool softener.
  • Movicol
    A stool softener, an equivalent of Miralax in UK.
  • Fybogel
    A laxative.
  • Milk of Magnesia (MoM)
    A laxative. Not really milk, but solution of magnesium hydroxide which gives it a ‘milky’ color and also available in tablet or pill form.
  • Citrucel
    A laxative. Where to buy?
  • Metamucil
    A natural laxative and fiber supplement.
  • Ibuprofen
    A pain-reliever and anti-inflammatory drug.
  • Nitroglycerin Ointment
    An ointment applied to the anus or anal fissure area to reduce pressure and allow healing. Usually dispensed in the form of 0.2% nitroglycerin ointment.
  • Lidocaine
    A local anesthetic drug, usually prescribed in topical form to relieve anal fissure pain or itching. Low concentrations of Lidocaine ointment is also available over-the-counter. Where to buy?

Lateral Internal Sphincterotomy

Lateral internal sphincterotomy (LIS) is the name for the surgical operation to make a cut on the sphincter muscle of the anus. LIS is a treatment for anal fissure. More accurately, the main purpose is to help the fissure to heal by itself, by relaxing the sphincter muscle through sphincterotomy.

“Lateral” is the surgical approach to start the incision entry. For some types of surgery, all lateral, posterior and anterior approaches can be used. For sphincterotomy, however, lateral approach is the only method used.

“Internal” refers to the internal sphincter, where the incision is targeted. The cut is often made to the superficial sphincter as this reduces the chance of side effects later.

Despite its rather complex-sounding name, lateral internal sphincterotomy is really a simple surgery to make one small cut to the anal muscle. It generally takes about 20 to 30 minutes to perform. And patients are admitted and discharged on the same day.

Lateral internal sphincterotomy operation itself does not remove skin tag. Anal skin tag can be removed by either ligation or cauterizing. Nevertheless, it is not uncommon to have both sphincterotomy and skin tag removal performed in the same operation.

Other related operation that might be performed with sphinterotomy (depending on the anal fissure conditions) are :

  • hemorrhoidectomy
  • fissurectomy
  • fistulotomy

Again, these operations can be performed together during lateral internal sphincterotomy. You should check with your surgeon the exact name of the operation to be performed. It is a good idea to confirm this with your nurse too, as they are the ones usually checking you into the operation theatre.

Overall, lateral internal sphincterotomy is not a risky procedure and complication rarely happens. Similarly, probability of side effects appears to be low, although there are no official statistics on patients sampling. With the right post-operation care, most patients can expect a full recovery and a normal life again.

Botox vs Sphincterotomy

Botox is commonly suggested as an early stage treatment for anal fissure. However, based on experiences of patients who went for Botox, their problem and pain usually comes back after a while.

Below is a comparison for Botox vs Sphincterotomy.

Botox Sphincterotomy
Uses Botulinum Toxin A Uses surgical operation and requires local or general anaesthesia
Treatment takes up to 3 months Same day admission and discharge. Operation takes 20 to 30 minutes
Success rate are 50% with 50% requiring treatment again Very effective with 90-95% success rate
Few side-effects Incontinence observed in 5% of the patients
Cost $400 -

Botox remains a reasonable method to treatment for anal fissure. However, sphincterotomy is considered the best treatment that will cure anal fissure once and for all. Whether you should go for botox or sphincterotomy depends on which treatment your are more comfortable with and of course, advise from your doctor or CRS.

Sphincterotomy Recovery – A Guide


You have done sphincterotomy, now what? Will this be a start of another harrowing experience? The path to sphincterotomy recovery is not a difficult one. With the right care and medication, you will be on your way to a normal and active lifestyle.

Many even reported signs of improvement as early as 2 weeks.

Below is a guide to sphincterotomy recovery, compiled based on real experience of patients and what worked for them.

Week 1

This is the week of patience as you will probably not see any improvement to your condition. In fact, you may still be in pain during this week. Taking care of personal hygiene is important during this time to avoid infection. You should also continue with medication prescribed and visit your doctor regularly.

Week 2

You most probably see some improvement during BM during this week. A key to recovery is to make sure you have enough of liquid and fiber intake to prevent hard stools.

Week 3

This is the week of healing. BM will be smooth and with little pain (or none at all). You could probably start doing some normal activities during this week. However, care should still be taken to continous healing.

Week 4 thereafter

After this week, you should be able to start work and your normal activities again. You should feel glad that you took sphincterotomy. BM is painless and spasms rarely occur. Although full recovery may take up to 2 months, with the right care, many sphincterotomy patients see recovery much earlier.

Do you really need to go for Sphincterotomy?

Chances are, you are here because your doctor suggested sphincterotomy procedure to treat your piles or anal fissures problem. You barely can pronounce the name correctly, let alone hear or know what it is.

Some questions ran quickly through your mind. How is it performed? Is it painful? What are the risks? What are the chances of recovery? What are the side effects?

I know. It is scary. But this article will explain based on real experiences of sphincterotomy treatment and recovery.

By the way, sphincterotomy is pronounced as sfink-ter-ro-te-mi. A surgical incision of a sphincter (muscles that control the anus). See What is Sphincterotomy?

Sphincterotomy is usually suggested to patients with the following conditions:

  • Anal muscle is abnormally tight.
  • Frequent spams during passing motion or BM (What is BM? See Glossary).
  • Scar tissue has formed from previous wounds and it takes long time to heal.

That being said, a sphincterotomy is a viable choice if you have been suffering from piles or anal fissures for a long time. You should also consider this procedure if the wound or tear is becoming bigger and taking longer to heal.

The sphincterotomy procedure is performed by cutting the sphincter to weaken the muscle, thereby reducing pressure and promote healing of the wounded area. It may also involve cleaning of scar tissues to prevent further tearing.

It may sound painful, but sphincterotomy can be performed with only local anesthesia. Many who went through the operation claims that the pain is much less compared to the pain of anal fissures itself.

You may feel continuing pain a few days after sphincterotomy (some reported up to a week). This could be quite depressing for some, especially those who think of sphincterotomy as the last resort.

However, the situation usually improves starting from the second week after the operation. Full recovery may take up to 2 months. See Sphincterotomy Recovery – A Guide. BM is painless and normal for most people after that.

Post-sphincterotomy care is necessary to ensure quick recovery and to help you deal with the temporary side-effects. Side-effects may include mucous around the scar, itching to inability to control BM and gas movement. It varies from person to person, so it is best to consult your doctor or surgeon.

During sphincterotomy recovery, you can take medications and supplements to soften stools (best taken at night for BM the morning after). A diet containing generous fiber and water intake is recommended.

Nowadays, sphincterotomy has almost 100% of success rate!