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Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 6773
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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I've had anal fissures 4 years now after not eating properly

Customer Question

I've had anal fissures for around 4 years now after not eating properly due to shift work.
my chronic fissure at the 6pm position healed nicely but the one at 12 position caused a flap of scar tissue which was excised last year (september ish?) I get no blood on bowel movement but the pain is around 7/10 and I would describe the pain as really scratchy, with no spasms after.
I had a feel up with some cream and I can clearly feel a scar on the anterior section just inside the sphincter ranging from the 11 to the 2 aclock position where my consultant cut away the scar tissue and stitched me up, this scar is causing me all the issues and I have no idea where I can go next to get it sorted. I'm a nurse and its interfering with my work.
the whole anterior section feels very tight with the scar and doesn't have any give when I go to the loo.
please help me, I don't know how long I can cope with this for.
Submitted: 10 months ago.
Category: Medical
Expert:  Dr Uzair replied 10 months ago.

Hi and thanks for the query.

Indeed, the inference drawn is right. I have seen a few cases where the anal verge and or the surrounding tissue was scarred resulting in constriction of part or all of the sphincter. This can be easily sorted out, but you will have to see a plastic and reconstructive surgeon for this.

Just simply excising the scar will cause the resulting fibrosis to again cause constriction and form a band. The best fix is to excise the scar and fill the defect with a local flap from the surrounding area, I have used limberg flaps in most instances and bring the surround skin as a flap in the defect left by the scar tissue, this introduction of good tissue fill the defect and breaks the scar and there is no constriction later on. With smaller scars like the one you have from the 11 to 2 O clock position, you will not even require post operative dilatations, which is the case with circumferential or near circumferential scars.

So, the best course of action will be to get assessed by a Plastic and Reonstructive surgeon.

Expert:  Dr Uzair replied 10 months ago.

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Wish you good health.