Brief Answer:
Suggest to rule out anal stenosis
Detailed Answer:
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Dear XXXXXXX
Pain and bleeding following rectal surgery for hemorrhoidectomy is most likely to be due to Fissure and stenosis of anal opening(Small opening). The outcome of this and respond to this will also depend what was done during second procedure.
Due to associated
fissure in ano, there is spasm of internal sphincter muscle of the rectum which delays healing of the ulcer, also stress and anxiety will provoke more spasm. So taking Xanex which is alprazolam which is anti
anxiety medication will help.
I think you are going on right rrack. Aim of the treatment should be
1. Help in smooth evacuation of stools- Any hard stools will further cause fissure and will promote internal
sphincter spasm. Stool softner laxative and local suppository will help (you are already on Canasa)
2. Relax the internal sphincter
3. Prevent scarring
I would suggest you the following measures to achieve it
1. Consume good quantity of water- atleast 2 to 3 liter a day.
2. High fiber diet
3. Avoid constipating diet- avoid refined wheat flour, biscuits and baked product
4. Oral laxative like Lactulose will be helpful
5. Local application of either Nifedepine/
nitroglycerin ointment to relax the internal sphincter will be helpful
6. Consult your physician to rule out persistent anal stenosis which could be cause of the synonyms
7. Local application of Steroid containing ointment will help prevent scarring and also treat proctitis if infection has been ruled out.
8. If infective pathology is ruled out, steroid enemas like
hydrocortisone enema will be helpful in providing much needed relief.
The confirmation whether it's Proctitis or IBD(
inflammatory bowel disease) can be by histopathology examination of tissue or
colonoscopy.
I would suggest you to discuss all this with your physician and you could plan the things further .
If you need any further clarification or suggestion,I would be glad to help you.
Wishing you a great and healthy life.
God bless
Take care
Best Regards
Dr Deepak Kishore
MBBS,MS,MCh
Consultant Surgeon
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