Anal warts, fissure and fistula surgery

Spire Harpenden Hospital is a leading private hospital, based in Hertfordshire in the South East of England. The hospital caters for a wide range of patients from Hertfordshire, Bedfordshire and Buckinghamshire, as well as from other parts of the United Kingdom and abroad. We use highly experienced and skilled consultants to carry out all our services including the treatment of anal warts, fissures and fistulas.

What is an anal fissure?

An anal fissure is a tear in the skin lining the inside of the anus. Anal fissures can be caused by constipation. Once the skin has a tear, the muscle underneath it can go into spasm. This tightens the anus further making it more painful and difficult to open your bowels, particularly if you remain constipated. You may also find that you pass blood and have a sore anus for a few hours after each bowel movement.

Some fissures heal on their own and this healing process can be helped by eating plenty of fruit and vegetables, and drinking lots of fluid to avoid constipation. If a fissure does not heal on its own, surgical treatment can help.

Anal sphincterotomy surgery involves making a cut in the ring of muscle (the sphincter) that controls the opening and closing of the anus. This will relax the sphincter and help prevent spasm. This means you will need to strain less when you go to the toilet, allowing the fissure to heal.

The surgeon is careful to make the cut in such a way that it should not allow the anus to open too easily and affect your continence (the ability to control gas and bowel movements).

Afterwards, a pad dressing will be put into your anus to help stop bleeding.

The operation is done under general anaesthesia. This means you will be asleep during the procedure and will feel no pain. Usually, the operation is done as a day-case, but sometimes you may need to stay overnight in hospital.

What is an anal fistula? 

An anal fistula is a tunnel connecting the skin near the anus to the inside of the bowel (usually the rectum). This means that the inside of the bowel is connected to the outside of the body through an additional opening. A fistula is usually the result of an infection or abscess in the anus. 

There are many different kinds of fistula. Some have a single tract (route) running from the bowel to the skin. Others branch into more than one tract. Sometimes they cross the muscles that control the opening and closing of the anus (sphincters). 

Anal fistulas are painful and the skin around the anus can swell. Your skin may also be itchy and irritated, and the fistula opening may be infected. Surgical treatment is usually needed to remove them. 

Anal fistula surgery is usually done under general anaesthesia. Usually, you will need to stay overnight in hospital. 

The exact operation will depend on the type of fistula you have. Ask your surgeon to discuss all the possible options with you. 

Once the anaesthetic has taken effect, your surgeon will examine the fistula and decide the best way to treat it. Usually, the aim is to open up the fistula tract to the outside so that the wound can heal from the base upwards. Stitches are generally not used, but sometimes a piece of suture (thread used for stitches) is left in place to help with healing. This is called a seton. The operation usually lasts about half an hour. 

What are anal warts? 

Anal warts (also called condyloma acuminata) are small growths of skin that appear around your anus. They are fairly common, and may be cut away using a surgical blade (scalpel), a laser or a heated instrument, depending on the size and location of the warts. The four options available are below. 

  • Electrocautery, also known as diathermy – warts are burnt off using a low-voltage electric current through a thin wire or probe. This method immediately seals the blood vessels, so no stitches are needed.
  • Loop electrosurgical excision procedure (LEEP) – this is similar to electrocautery, but the wire or probe has a loop on the end to remove the warts.
  • Surgical removal – warts are cut away using a scalpel. Dissolvable stitches are used to close the wound.
  • Laser ablation – a high-energy beam of light destroys the warts. It seals blood vessels so you won't need stitches. 

Warts are caused by a virus called human papilloma virus (HPV). The virus infects the top layers of your skin. Warts should be removed since they can grow and spread, causing discomfort and affect your bowel movements. 

Removing the warts does not mean you are free from HPV. The virus can live in normal tissue for up to six months. This means you may still be infectious after this operation and warts may re-occur, needing further treatment. 

Surgery to remove anal warts is usually done under general anaesthesia. If the warts are very small you may have a local anaesthetic. This means you will be awake but the area will be numb. Usually, the operation is done as a day-case, requiring no overnight stay. 

After an operation to repair an anal fissure or fistula, you are likely to feel sore for a number of days – the exact length of time will depend on the type of the procedure you have. 

Operations to repair an anal fissure or fistula or to remove anal warts are commonly performed and generally safe. For most people, the benefits outweigh the disadvantages. However all surgery carries an element of risk. 

The possible complications of any surgery include an unexpected reaction to the anaesthetic, excessive bleeding, infection or developing a blood clot in the veins of one of your legs (deep vein thrombosis, DVT). 

Your surgeon will explain the benefits and associated risks of these procedures and will also discuss any alternatives to surgery.

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