Lateral Internal Sphincterotomy: What to Expect at Home

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Your Recovery

Lateral internal sphincterotomy is surgery to help heal an anal fissure that has not improved with medicine or other treatments. Most people notice that the pain from an anal fissure goes away within a few days after the surgery. You may be worried about having a bowel movement after your surgery. You will likely have some pain with bowel movements at first, but it should be less than what you had before the surgery. You may notice some blood on your toilet paper after you have a bowel movement for the first few weeks after surgery. You can make your bowel movements less painful by getting enough fibre and fluids and using stool softeners or laxatives. Sitting in warm water (sitz bath) after bowel movements will also help.

Most people can go back to work and their normal routine 1 to 2 weeks after surgery. It will probably take about 6 weeks for your anus to completely heal. Most people get better without any problems. But a small number of people have problems controlling stools when they pass gas. This usually gets better with time.

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

How can you care for yourself at home?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover.
  • Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
  • Ask your doctor when you can drive again.
  • Most people are able to return to work 1 to 2 weeks after surgery.
  • Shower or take baths as usual. Pat your anal area dry with a towel when you are done.

Diet

  • You can eat your normal diet. If your stomach is upset, try eating bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
  • Drink plenty of fluids (unless your doctor has told you not to).
  • It is important to eat high-fibre foods after your surgery. This will make it easier to have bowel movements.
  • You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
  • If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do.
  • Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Pain medicine may cause constipation. Ask your doctor about taking a stool softener along with your pain medicine. Drink plenty of fluids.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
  • If you think your pain medicine is making you sick to your stomach:
    • Take your medicine after meals (unless your doctor has told you not to).
    • Ask your doctor for a different pain medicine.

Other instructions

  • Sit in 8 to 10 centimetres of warm water (sitz bath) for 15 to 20 minutes 3 times a day and after bowel movements. Then pat the area dry. Do this as long as you have pain in your anal area.
  • Support your feet with a small step stool when you sit on the toilet. This helps flex your hips and places your pelvis in a squatting position. This can make bowel movements easier after surgery.
  • Use baby wipes or medicated pads, such as Tucks, instead of toilet paper after a bowel movement. These products do not irritate the anus.
  • Avoid using soaps with fragrance that can irritate the site.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have sudden chest pain and shortness of breath, or you cough up blood.
  • You have severe belly pain.

Call your doctor or nurse call line now or seek immediate medical care if:

  • You have bleeding from your anus that soaks 2 or more large gauze pads.
  • You have pain that does not get better after you take your pain medicine.
  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the site.
    • Pus draining from the site.
    • Swollen lymph nodes in your neck, armpits, or groin.
    • A fever.
  • You have stool leaking from your anus, or you cannot control when you have a bowel movement.

Watch closely for any changes in your health, and be sure to contact your doctor or nurse call line if:

  • You do not have a bowel movement after taking a laxative.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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