Brief Answer:
Lateral internal sphincterotomy is the current procedure of choice for the cure.

Detailed Answer:

Hello,

Lateral internal sphincterotomy is the current procedure of choice for care. Medical therapy can only control symptoms but the cure is through sphincterectomy.

Medication alone can cure fissures only in very few cases. So in case you are not relieved by medicines just ask you, doctor, to go for a lateral internal sphincterotomy. It is the most commonly used procedure for anal fissures.

The success rate is about 95% and the patient was discharged 48 hours post surgery.

However, if you want to remain on medical therapy only then Sitting in warm water (sitz bath) after bowel movements will also help but I don't think it will cure you.

The cure is through surgery.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Ramesh Kumar, Gastroenterologist

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Brief Answer:
Follow up.

Detailed Answer:

Hi,

Initially, you have written that you are a diagnosed case of anal fissure but your description is suggestive of hemorrhoid.

So please clarify who suggested that its an anal fissure?

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Ramesh Kumar, Gastroenterologist

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Brief Answer:
It can be hemorrhoid.

Detailed Answer:

Hi,

According to standard texts Hemorrhoids are classified as-
Grade 1: hemorrhoid bulges into the canal but does not prolapse or fall completely into it. These may bleed.
Grade 2: hemorrhoid protrudes past the anal verge with straining for a bowel movement or passage of flatus, but spontaneously return to their original internal position once the straining has subsided.
Grade 3: the hemorrhoid may protrude past the anal verge without any straining and requires the patient to push them inside manually.
Grade 4: the internal hemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm.

Your case is grade 2 or 3 hemorrhoid.

Three types of managements are there
1) Conservative
2) Non-invasive
3) Invasive surgical

Initially, we start with conservative management for at least 3 months-
Suggestion for conservative management are-

Start taking Syp. Lactulose. It is one of the most frequently used laxatives, tolerated very well by patients in long terms with minimal side effects. Using laxative would prevent straining while defecating.

-Secondly, continue using Prepration H
Thirdly, request your gastroenterologist to prescribe you with oral Calcium Dobesilate-Doxium therapy. Trials have shown that 3-month therapy can cause shrinkage of hemorrhoids in almost 60% cases. It was demonstrated that calcium dobesilate decreased capillary permeability, inhibited platelet aggregation and improved blood viscosity; thus resulting in the reduction of tissue edema.

If not relieved then surgery can be planned.

Add Metamucil/Fybrogel to your regimen. It's a natural laxative containing husk. It absorbs water from the intestine and swells up making passage of stool easy and add bulk to stool.

Taking a Sitz bath will help.

Hope I provided you with the information you wanted.

Regards,
Dr. Ramesh Kumar, Gastroenterologist

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