Managing Hemorrhoids: Suppositories, Steroids, and Anal Fissures

Hemorrhoidal suppositories & corticosteroids & wounds (fissures)

Hello, doctor! I'm sorry to bother you again...
At the beginning of the month, I had a hemorrhoid banding procedure for an internal hemorrhoid.
However, during the second week, I experienced diarrhea which caused fissures inside.
Whenever my stool is a bit hard or I exert myself, there is blood.
The hospital prescribed a suppository called Abor Hemorrhoid, which does not contain steroids, but the ointment they prescribed, Hiyu Hemorrhoid, contains a bit of steroids.
Since I have an open wound, I only dare to use the suppository.
During my follow-up visit, the doctor mentioned that after using it for a while, I should reduce its use to avoid irritating the wound, so I have been doing more sitz baths.
The pharmacist said that most suppositories do not contain steroids because they might affect the wound, although some do, depending on the hospital's usage.
Both the ointment and the suppository are effective for pain relief, but I still have concerns about the steroids regarding the bleeding wound...
After the banding of the internal hemorrhoid, the external anal sphincter started to swell, and it is very painful when pressed.
The doctor said it is a thrombosed external hemorrhoid...
I initially thought it would go away, but it seems to be getting larger...
Can this be removed in an outpatient procedure? I'm worried about damaging the sphincter since it is injured.
I have irritable bowel syndrome, so I tend to have bowel movements easily.
If I take anti-diarrheal medication, my stool will not be soft.
Currently, I can only take gas relief medication and simethicone.
Although I may have to go to the bathroom four to five times a day, if it's all soft stool, it is not diarrhea.
However, if I use the suppository before bed, my first bowel movement in the morning tends to be harder.
I'm concerned that this cycle of re-bleeding will prevent healing! If it really cannot heal on its own, will surgery be the only option? I have a fissure about one to two centimeters deep on the right side inside the anus, and the doctor said surgery cannot address it, so I am unsure what to do.
It has been almost two weeks, and it is still the same...
I see that some hospitals have rectal repair techniques; would this be helpful? It seems like it would require a temporary colostomy until the wound heals before resuming normal function? Thank you for your assistance, doctor!

ken, 40~49 year old female. Ask Date: 2016/04/18

Dr. Ke Fangxu reply Surgery

1.
If the thrombosed external hemorrhoid is not large, it can be surgically excised under local anesthesia in an outpatient setting without damaging the sphincter muscle.
2.
There are specific medications for irritable bowel syndrome, and it is recommended that you consult a gastroenterologist for a prescription.
If the hemorrhoidal bleeding is not severe enough to cause anemia, surgery may not be necessary.
3.
Regarding the internal anal fissure you mentioned, I cannot provide a diagnosis without a physical examination.
It is unlikely to be severe enough to require rectal repair or colostomy surgery.
I suggest you first focus on regulating your bowel movements.

Reply Date: 2016/04/18

More Info

Managing hemorrhoids, particularly when complications such as anal fissures and thrombosed external hemorrhoids arise, can be quite challenging. Your situation, involving a recent internal hemorrhoid ligation followed by diarrhea and subsequent anal fissures, is not uncommon. Let's break down the management strategies and considerations for your case.

Understanding Your Condition
1. Internal Hemorrhoids: These are swollen veins inside the rectum. Ligation is a common treatment that can effectively reduce symptoms, but it can lead to complications like fissures if bowel movements are hard or if there is straining.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools or prolonged diarrhea. They can be painful and may bleed, especially during bowel movements.

3. Thrombosed External Hemorrhoids: These occur when a blood clot forms in an external hemorrhoid, leading to swelling and significant pain. The fact that you are experiencing increasing swelling and pain suggests that this may be a concern.

Treatment Options
1. Topical Treatments:
- Suppositories: The use of non-steroidal suppositories, like the one you mentioned (雅伯痔), can help soothe the area and promote healing without the risk of steroid-related complications. However, they may not be as effective for pain relief compared to steroid-containing options.

- Steroid Creams/Ointments: While steroids can reduce inflammation and pain, they can also thin the skin and potentially delay healing if used excessively. Your doctor’s advice to limit their use is prudent, especially with an open fissure.

2. Sitz Baths: Regular sitz baths can help relieve pain and promote healing by keeping the area clean and reducing inflammation. This is a beneficial practice that you are already following.

3. Dietary Adjustments: Since you have irritable bowel syndrome (IBS), managing your diet is crucial. Aim for a high-fiber diet to soften stools and reduce straining. If diarrhea is a frequent issue, consider consulting a dietitian to help manage your symptoms effectively.

4. Pain Management: Over-the-counter pain relievers can help manage discomfort. However, be cautious with any medications that may exacerbate gastrointestinal symptoms.

Surgical Considerations
1. Thrombosed External Hemorrhoids: If the thrombosed hemorrhoid is causing significant pain and does not improve with conservative measures, surgical intervention may be necessary. This can often be done in an outpatient setting, and while there is a risk of affecting the anal sphincter, skilled surgeons can minimize this risk.

2. Anal Fissure Repair: If the fissure does not heal with conservative management, surgical options such as lateral internal sphincterotomy may be considered. This procedure can relieve tension in the anal sphincter, allowing the fissure to heal.

3. Rectal Repair Techniques: The rectal repair techniques you mentioned, including temporary colostomy, are generally reserved for more severe cases or when there is significant tissue damage. This is not a first-line treatment and would typically be considered only if other methods fail.

Follow-Up and Monitoring
Given that you have been experiencing persistent symptoms for nearly two weeks, it is essential to follow up with your healthcare provider. They may recommend further evaluation, possibly including imaging studies or a referral to a colorectal specialist, to assess the extent of your condition and determine the best course of action.

Conclusion
In summary, managing your hemorrhoids and associated complications requires a multifaceted approach, including topical treatments, dietary management, and possibly surgical intervention if conservative measures fail. Regular follow-up with your healthcare provider is crucial to monitor your condition and adjust treatment as necessary. If your symptoms persist or worsen, do not hesitate to seek further evaluation. Your comfort and quality of life are paramount, and effective management is achievable.

Similar Q&A

Managing Pain from Anal Fissures and Hemorrhoids: Effective Treatments

I have been using hemorrhoid cream for 5 months due to anal fissures, and now the protective layer around my anus (hemorrhoids) is gone. I experience pain in my buttocks when riding a motorcycle or bicycle, and I'm unsure how to address this issue. Thank you, doctor.

Dr. Zhang Shuhao reply Surgery
It may be caused by excessive use of steroid-containing ointments. First, stop using hemorrhoid treatments and avoid excessive cleaning of the anal and perineal area. You can use simple moisturizing products such as lotions. If symptoms do not improve, you should visit a dermatol...

Effective Treatments and Medications for Anal Fissures: A Guide

Hello, doctor. Recently, I have been experiencing bleeding during bowel movements, possibly due to increased stress. What treatment options are available, and what medications should I apply? Thank you for your guidance.

Dr. Hou Yongji reply Surgery
1. If there is rectal bleeding, it is essential to be examined by a specialist. Do not assume it is hemorrhoids or anal fissures and treat it casually. 2. In young individuals, rectal bleeding is often due to anal fissures, most of which will heal naturally. Treatment should foc...

Managing Anal Fissures: Effective Use of Topical Treatments

Hello, Dr. Ko. Since July of this year, I have been experiencing pain and bleeding during bowel movements, with symptoms that fluctuate. There is a swollen, yellowish lump outside my anus. Initially, I thought it was hemorrhoids, and in August, I purchased a suppository from Take...

Dr. Ke Fangxu reply Surgery
1 & 2. The main function of this ointment is the petroleum jelly component, which serves as a lubricant. Since petroleum jelly is not classified as a medication, this ointment is eligible for health insurance coverage. Therefore, either option can be applied. 3. It is accepta...

Managing Anal Fissures and Hemorrhoids: Your Questions Answered

Hello Doctor: A few days ago, due to being busy with work in the southern part of the country, I was unable to eat properly, which caused constipation and harder stools. After having a bowel movement, I noticed some blood when wiping. After seeing a doctor, I was diagnosed with i...

Dr. Yang Zhichao reply Gastroenterology and Hepatology
Hello, Zhixuan. 1. If your symptoms have improved, you may not need to continue using the medication. The remaining suppositories can be used if needed in the near future. 2. It is normal to experience a feeling of urgency to defecate when using suppositories, and some odor an...