Do I Really Need Surgery for My Anal Fissure?

Is surgery absolutely necessary?

Hello, Dr.
Ke.
I discovered around last September that I would experience pain in a specific area during bowel movements (the pain lasted for a while, but I didn't notice it due to constipation, and there was no growth at the anal opening at that time).
After visiting the outpatient clinic, the doctor diagnosed me with an anal fissure and prescribed magnesium oxide and ointment.
About a week later, I healed, but I stopped taking the medication immediately because some doctors online advised against using stool softeners, claiming they could reduce anal elasticity.
However, I did not pay attention to improving my constipation, so when I had a bowel movement every two days, the hard stool would cause me to re-injure myself.
I later noticed a small white growth at the anal opening, which I thought was related to the internal hemorrhoid since it was located right at the site of the injury and the internal hemorrhoid.
It wasn't until last week during my appointment that the doctor told me my anal fissure hadn't healed.
He didn't specify whether it was acute or chronic, nor did he mention the growth (I was too nervous to ask).
He prescribed magnesium oxide and Laxative Granules, and I felt immediate relief after taking them.
After about five days, the pain at the wound site subsided, and my bowel movements changed from every two days to daily.
The stool has become thinner, and I am also seeing a traditional Chinese medicine practitioner to help with my constipation.
I would like to ask you: 1.
Am I experiencing a chronic anal fissure? 2.
Is surgery absolutely necessary? I currently do not feel any pain, but many articles online state that surgery is unavoidable, which frightens me.
Last week, the doctor only reminded me to pay attention to my diet.
3.
Is the thinning of my stool related to the stool softeners, or is it due to the increased frequency of bowel movements? 4.
Is there a way to self-assess anal narrowing? Thank you for your patience in reading this.

Lin, 20~29 year old female. Ask Date: 2016/04/05

Dr. Ke Fangxu reply Surgery

1.
Chronic anal fissure is characterized by persistent pain and bleeding symptoms that do not improve.
Polyps at the anal opening are remnants of the fissure, and as long as there is no discomfort, they do not require attention.
2.
No need.
3.
Narrow stools are often caused by prolonged sitting during bowel movements due to hemorrhoid swelling.
Reducing the time spent on the toilet can help improve this condition, and it is advisable to avoid using a smartphone or reading while defecating.
4.
Anal stenosis generally occurs in patients who have undergone anal surgery, and severe chronic anal fissures may also lead to this condition.
If a single finger cannot be inserted into the anus, it can be indicative of anal stenosis; however, self-examination is not recommended as it may cause injury to the anal area.

Reply Date: 2016/04/05

More Info

When it comes to anal fissures, the decision to undergo surgery is often a complex one that depends on various factors, including the duration and severity of the fissure, the effectiveness of conservative treatments, and the overall health of the patient. Based on your description, it seems you have been dealing with an anal fissure for some time, and while you have experienced periods of improvement, there are still concerns regarding the potential for chronicity and the presence of a small growth at the fissure site.

1. Chronic vs. Acute Fissure: The distinction between acute and chronic anal fissures is primarily based on the duration of symptoms. An acute fissure is typically defined as one that has been present for less than six weeks, while a chronic fissure lasts longer and may show signs of tissue changes, such as the formation of a sentinel pile or skin tag. Given that you have had recurrent symptoms and the presence of a small growth, it is possible that your fissure has become chronic. Chronic fissures are less likely to heal on their own and often require more aggressive treatment.

2. Surgical Intervention: Surgery is not always necessary for anal fissures, especially if conservative treatments are effective. Many patients respond well to dietary changes, stool softeners, topical medications, and lifestyle modifications. However, if conservative measures fail and the fissure persists, surgical options such as lateral internal sphincterotomy may be considered. This procedure involves cutting a portion of the anal sphincter muscle to relieve tension and promote healing. It is important to discuss your concerns with your healthcare provider, as they can provide personalized recommendations based on your specific situation.

3. Effect of Stool Softeners: The use of stool softeners can significantly improve bowel movements by making stools easier to pass, which is crucial for healing anal fissures. If you have noticed that your stools have become thinner and your bowel movements have increased in frequency, this could be a positive sign that the stool softeners are working. However, it is essential to maintain a balance; excessive use of laxatives or stool softeners can lead to dependency or changes in bowel habits. It is advisable to follow your doctor's recommendations regarding the use of these medications.

4. Assessing Anal Narrowing: Determining whether you have anal narrowing (stenosis) can be challenging without a clinical examination. Symptoms of anal stenosis may include difficulty passing stools, a feeling of incomplete evacuation, or pain during bowel movements. If you are concerned about this issue, it would be beneficial to discuss it with your healthcare provider, who may perform a physical examination or recommend further diagnostic tests.

In summary, while surgery can be an effective treatment for chronic anal fissures, it is not always the first line of action. Many patients find relief through conservative measures. It is crucial to maintain open communication with your healthcare provider, follow their recommendations, and address any concerns you may have about your condition. If you continue to experience symptoms or have questions about your treatment options, consider seeking a second opinion or consulting a specialist in colorectal surgery for further evaluation. Your health and comfort are paramount, and there are various avenues to explore for effective management of your anal fissure.

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