I have a mild but persistent fisure. Im 69 y/o male. I experience mild pain on defacation but it doesnt continue. Often there is a small amount of blood of the feces are hard or large. Are there treatments that will actually CURE the problem (i.e. allow me to have normal movements without fear of re-injury) or is just stool softening the only answer?
Hi. Welcome to JustAnswer. I shall try my best to assist you while you are corresponding with me.This is most likely a chronic anal fissure with acute exacerbation every now and then due to passage of hard stools. The treatment of acute and chronic anal fissures vary greatly. In the setting of a new and acute anal fissure, one has to resort to stool softening agents and use of a high fiber diet and plenty of water, along with application of GTN 0.2 percent cream on the injured area to increase the blood supply and promote healing also to relieve the spasm to some extent which is one of the main reasons that the fissure does not heal. Along with GTN which remains the prime modality of treatment in acute cases, application of Lidocaine 2 percent creams on the injured area also relieves the pain and the spasm. Other than that a technique called the Sitz bath is compulsory to keep the area clear and clean of any bacteria, in this technique, a tub of Luke warm water should be prepared and about 50 ml of Povidone-Iodine antiseptic solution is admixed in it. The patient has to sit in the tub for 15 to 20 minutes thrice a day specially after passage of stools.The above management will do away with the fissure in 2 to 3 weeks, but during this time, constipation is to be avoided at all costs or it will re injure the area while it is healing setting the process back to where it started.Now, chronic anal fissures are the ones which are difficult to treat conservatively, these are not as frank in presentation as acute fissures and are easily recognizable on a physical examination, a skin tag over the fissure is characteristic and the area is not inflamed except a collage of granulation, scarring and fibrosis is seen. These fissures never heal spontaneously and keep getting infected and injured again and again.For chronic anal fissures the treatment is surgical intervention. Fistulotomy and excision of the scar tissue is required and can be done as a day care procedure under spinal anesthesia by a perianal or a general surgeon.I suggest that you see a Perianal or a general surgeon to get this evaluated, long standing chronic anal fissures can turn in to fistulas further complicating the problem.More queries, please reply.Do leave positive feedback while you rate my answer.Best.Dr Uzair41045.7513778588
From what you say and my experience I guess this qualifies as a chronic fissure, since I can feel it on self-examination as a slender hard row of tissue entending into the anus. I have had the condition on some level for two or three years and It has gone through periods of not being symtomatic at all, but is still palpable. What sort of results can be expected from surgery, and what is the regimen for recovery? Will the former fisure always remain subject to re-injury? I appreciate your advice about possible complications.
Thanks for the reply.If you have had it for 3 years then this is a chronic anal fissure especially judging from the examination details you have provided.The results of surgery are very good but recurrence is always a possibility if you are not careful with keeping the constipation in check. The recurrence or nonhealing rates for anal fissures after surgical treatment are 1-6% and these too are for complex fissures with underlying tuberculosis etc. which does not seem to be true in your case.Your surgeon will prescribe stool softeners postoperatively and you have to be on a high fiber diet to avoid a repeat injury.The surgery is known as Lateral Internal Sphincterotomy and it usually takes 15 to 20 minutes for the procedure itself.Do leave positive feedback while you rate my answer.Best.