A lateral internal sphincterotomy can offer life-changing relief from the unrelenting pain of a chronic anal fissure. But once the surgery is done, what comes next? For many patients, the path to recovery brings new questions—and sometimes anxiety—about bowel habits, discomfort, and the dreaded possibility of incontinence.
This in-depth guide explores what life looks like after a sphincterotomy. We’ll cover how bowel movements change, how to manage post-op pain, and what you really need to know about incontinence risks. Whether you’re preparing for surgery or navigating recovery, here’s what you need to know.
Understanding the Procedure: What Sphincterotomy Actually Does
Sphincterotomy involves cutting a small portion of the internal anal sphincter muscle to relieve spasm and improve blood flow—key factors in healing a chronic anal fissure. By reducing pressure inside the anal canal, the fissure is given a chance to heal naturally. It’s often done on an outpatient basis and has a success rate of over 90%.
But surgery is only one step. The real transformation happens in the days, weeks, and months that follow.
Early Postoperative Period: The First Week
Pain Levels and Management
Many patients are surprised to find that post-operative pain is often less than the pain caused by the fissure itself. However, discomfort during bowel movements is still common in the first 3–5 days.
To manage pain:
- Use over-the-counter analgesics like ibuprofen or acetaminophen.
- Sitz baths (warm water soaks) after every bowel movement can soothe the surgical area.
- Avoid spicy foods or acidic items that may irritate the anal lining.
Bleeding and Discharge
It’s normal to experience a small amount of bleeding or yellowish discharge from the surgical site for up to a week. Wearing a panty liner or light pad can help manage this without embarrassment.
Bowel Movements After Sphincterotomy: What to Expect and How to Help
The First Bowel Movement
This is often the most anxiety-inducing moment of recovery. While it may be uncomfortable, staying ahead with stool softeners and a high-fiber diet usually helps ease the process.
Tips to ease your first few bowel movements:
- Begin stool softeners like polyethylene glycol or lactulose on the day of surgery.
- Drink at least 2–3 liters of water daily.
- Stick to a fiber-rich diet with oats, fruits, and vegetables.
- Avoid holding in stool; delaying can lead to straining and pain.
Consistency and Routine
After the first week, bowel movements typically normalize. What’s essential is avoiding constipation. Straining can not only delay healing but may also cause recurrence of the fissure or discomfort at the surgical site.
Some patients may experience temporary urgency or looser stools. This generally resolves within a few weeks as the sphincter muscle and surrounding tissues adjust.
Risk of Incontinence: Is It as Common as People Fear?
The fear of incontinence is perhaps the most common hesitation before undergoing sphincterotomy. Fortunately, for most patients, the risk is low—especially when performed by experienced colorectal surgeons.
What Types of Incontinence Can Occur?
- Flatus (gas) incontinence: Difficulty controlling gas is the most common and often temporary.
- Stool staining: Minor leakage, particularly after loose stools, may occur in the first few weeks.
- Fecal incontinence: Rare but possible, especially in patients with previous anorectal surgeries, older adults, or women with prior obstetric injuries.
Who Is at Higher Risk?
- Age above 65
- History of vaginal delivery with perineal tears
- Prior anorectal surgery
- Pre-existing sphincter weakness (assessed via manometry)
If any of these apply, your surgeon may perform sphincter function testing before surgery or consider alternative treatments like Botox injections.
Wound Healing and Long-Term Care
How Long Does It Take to Heal Completely?
Initial healing often occurs by 4–6 weeks. However, deeper tissue remodeling continues for several months. Most patients can resume daily activities within 7–10 days but are advised to avoid heavy lifting, strenuous workouts, or long-distance travel for a couple of weeks.
Signs of Proper Healing:
- Reduced pain during bowel movements
- No persistent bleeding
- Gradual return to normal bowel consistency
- Disappearance of fissure-related spasms or tearing sensation
If symptoms linger beyond 8 weeks or worsen, a follow-up is necessary to rule out infection, recurrence, or incomplete healing.
Lifestyle Changes to Support Recovery and Prevent Recurrence
A sphincterotomy is highly effective, but lifestyle plays a big role in ensuring long-term success.
- Adopt a Consistent Bowel Routine
Try to have a bowel movement at the same time daily. The morning is ideal after a glass of warm water and light physical activity.
- Focus on Hydration and Diet
Drink water throughout the day and avoid processed foods, red meats, and low-fiber snacks. Psyllium husk or natural fiber supplements can help if your diet lacks consistency.
- Learn Proper Toilet Habits
- Avoid straining and prolonged sitting.
- Don’t ignore the urge to go.
- Use a footstool to elevate your knees if needed to help pass stool more easily.
- Reduce Anal Irritation
Avoid harsh soaps or wipes. Use water and gentle dabbing for cleaning. If itching persists, consult your doctor before using any over-the-counter ointments.
When Should You Call Your Doctor?
While minor discomfort is expected, contact your provider if you experience:
- Fever over 100.4°F
- Increasing pain after the first few days
- Foul-smelling discharge
- Uncontrolled bleeding
- Signs of fecal incontinence beyond two weeks
Sexual Activity After Sphincterotomy
It’s generally safe to resume sexual activity after 2–3 weeks, depending on comfort and healing. However, anal intercourse should be strictly avoided until cleared by your surgeon, as it may disrupt healing tissues and increase the risk of complications.
Emotional Impact and Mental Health
Don’t underestimate the psychological toll of chronic fissures and recovery from surgery. Many patients experience anxiety about recurrence or embarrassment over bowel symptoms. It’s okay to talk to your doctor—or a mental health provider—if recovery triggers emotional stress.
Knowing what’s normal and what isn’t can ease the recovery process.
FAQs About Life After Sphincterotomy
Q: Can I drive after sphincterotomy?
Yes, typically within 2–3 days, once you’re no longer taking strong pain medications and can sit comfortably.
Q: Will I need a follow-up visit?
Yes, most surgeons schedule a follow-up 2–4 weeks after surgery to check healing progress.
Q: Can fissures come back after sphincterotomy?
Rarely, especially if you maintain healthy bowel habits. If symptoms recur, your doctor may explore additional evaluations.
Q: What if I develop another anorectal condition later?
Past sphincterotomy may affect how future procedures are planned. Always inform your doctor of your surgical history.
Conclusion: What Life Really Looks Like After Sphincterotomy
Life after sphincterotomy can be transformative—pain-free mornings, easier bowel movements, and improved quality of life. While the first week requires careful attention to hygiene, diet, and rest, the long-term outlook is overwhelmingly positive for most patients.
By following post-op care instructions and committing to healthy bowel routines, patients can not only heal but also reduce the chances of fissures ever returning.
Your recovery doesn’t end with the surgery—it begins there.
