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Why Do I Experience The Pain Of Having An Anal Fissure Even After It Is Completed Treated And Cured?
Question: Back in 2010, I had my hemorrhoids removed via banding. Everything went well except that I got an anal fissure. The General Surgeon advised that I should apply Preparation H for a couple weeks and it would go away. However, it didn’t clear up. I went to another General Surgeon and he told me I had an acute/chronic anal fissure. He prescribed an ointment, a mixture of Nifedipine .3% with Lidocaine 5%. It did not work. He gave me a couple of injections of Botox, it didn’t work. Back to the ointment. Performed a sigmoidoscopy; results were negative. Back to the ointment. Performed a sphincterotomy. It didn’t work. Back to the ointment. Had several follow up appointments over the next of couple of years and the fissure cleared up sometime in 2013.
In early March 2018, the symptoms return. I don’t know if it has anything to do with it but I was biking a lot. Had a consult with a General Surgeon. Upon visual inspection he concluded that I had an anal fissure and prescribed the same ointment as before. Was not getting better. I went to another General Surgeon and he performed an Anoscopy. He advised that the canal was clean; no presence of hemorrhoids or an anal fissure. Asked why I had all the classic symptoms, especially pain after a bowel movement, of an anal fissure. He advised that he did not know and that he could not do anything for me and that I should see my GP.
Comments please.
In early March 2018, the symptoms return. I don’t know if it has anything to do with it but I was biking a lot. Had a consult with a General Surgeon. Upon visual inspection he concluded that I had an anal fissure and prescribed the same ointment as before. Was not getting better. I went to another General Surgeon and he performed an Anoscopy. He advised that the canal was clean; no presence of hemorrhoids or an anal fissure. Asked why I had all the classic symptoms, especially pain after a bowel movement, of an anal fissure. He advised that he did not know and that he could not do anything for me and that I should see my GP.
Comments please.
Brief Answer:
Multi-factorial problem.
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
Noted the history well and understood the concerns.
My thoughts:
Regular Sitz bath in a tub with warm water before and after passing stool helps a lot.
Since your problem of pain has recurred indicate that there has to be a cause that instigate or enhance the symptoms and can be one or a combination of the following:
Occasional passage of hard stool or needing extra straining to pass stool.
There is a role of stress and anxiety in such recurrences in some cases.
Biking a lot increases pressure on the anal verge, accumulates sweat and gives sort of wetness to the area allowing easy formation of fissure even on slight pressure.
Another least talked about observation is intolerance to certain foods, additives in foods and beverages that gives sort of pain at the anal area as the last General Surgeon has said that there are no piles or fissure and you still have classical pain. There is formation of edema of some sort that gives symptoms. This can be any beverages, alcohol of any sort, preserved foods and so on. Keen observation by you alone can help you to find such a thing and stopping this would help you a lot and avoid further recurrences. Please give me feedback on all these points to have fruitful discussion helping you.
Take sitz bath, stool softeners and laxative as needed.
Try to keep the area well ventilated by using loose underwear and pants.
Avoid Driving, biking and such activities.
Using doughnut pillows helps a lot.
Avoid stress and anxiety.
Identify the foods and beverages that instigate or enhance the problems and stop these altogether.
I hope this insight helps you.
I would be happy to hear from you, have interaction to get you the cause and have curative management.
Take care.
With Regards.
Multi-factorial problem.
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
Noted the history well and understood the concerns.
My thoughts:
Regular Sitz bath in a tub with warm water before and after passing stool helps a lot.
Since your problem of pain has recurred indicate that there has to be a cause that instigate or enhance the symptoms and can be one or a combination of the following:
Occasional passage of hard stool or needing extra straining to pass stool.
There is a role of stress and anxiety in such recurrences in some cases.
Biking a lot increases pressure on the anal verge, accumulates sweat and gives sort of wetness to the area allowing easy formation of fissure even on slight pressure.
Another least talked about observation is intolerance to certain foods, additives in foods and beverages that gives sort of pain at the anal area as the last General Surgeon has said that there are no piles or fissure and you still have classical pain. There is formation of edema of some sort that gives symptoms. This can be any beverages, alcohol of any sort, preserved foods and so on. Keen observation by you alone can help you to find such a thing and stopping this would help you a lot and avoid further recurrences. Please give me feedback on all these points to have fruitful discussion helping you.
Take sitz bath, stool softeners and laxative as needed.
Try to keep the area well ventilated by using loose underwear and pants.
Avoid Driving, biking and such activities.
Using doughnut pillows helps a lot.
Avoid stress and anxiety.
Identify the foods and beverages that instigate or enhance the problems and stop these altogether.
I hope this insight helps you.
I would be happy to hear from you, have interaction to get you the cause and have curative management.
Take care.
With Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Should I keep using the ointment (Nifedipine .3% with Lidocaine 5%) in your opinion. It seems to be the only thing that really provides relief? Any idea how long it could take to heal? What about the discrepancy between the two surgeons' diagnoses? Basically, one says there is a fissure while the other one says there is none.
Brief Answer:
As detailed below.
Detailed Answer:
Since Botox and Nifedipine has not worked last time as you have mentioned, it may not work now. Try it and continue if it is helping.
Fissure in ano can heal within a few day if the stools are soft and if the fissure in not infected, This may be the reason that another surgeon said everything is normal.
It is unpredictable to say about the time required for healing of fissure.
I hope this answers you queries.
Please consider all the points as mentioned above and get treated accordingly.
As detailed below.
Detailed Answer:
Since Botox and Nifedipine has not worked last time as you have mentioned, it may not work now. Try it and continue if it is helping.
Fissure in ano can heal within a few day if the stools are soft and if the fissure in not infected, This may be the reason that another surgeon said everything is normal.
It is unpredictable to say about the time required for healing of fissure.
I hope this answers you queries.
Please consider all the points as mentioned above and get treated accordingly.
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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