Why Using Suppositories Increased My Pain: A Patient's Dilemma

The pain has worsened with the use of the suppository!

Hello, doctor! I have had a fissure on the right side for over two weeks.
At first, I used ointment, suppositories, and sitz baths.
After a week, the pain decreased, so I continued with the ointment and sitz baths.
Yesterday, I only felt occasional pain, which was not as severe as at the beginning, and today was similar.
So, I decided to try the suppository again today, but shortly after using it, I felt increasing pain! It seemed like the pain intensified as if it was irritated or stretched and reopened.
I waited for over an hour, but the pain persisted! So, I expelled it and then took a sitz bath, which alleviated the pain.
It was not as painful as yesterday, but it was still more painful than before or when I used the suppository today.
Should I avoid using the suppository? It seems that I only used it during the first week, and after that, I stopped using it, and with continuous sitz baths and applying ointment for two weeks, I felt much better.
The doctor at the hospital previously mentioned that it is indeed difficult to heal, but he said that sitz baths only help relieve pain and do not promote wound healing.
He also explained that this type of internal wound cannot be surgically treated because it is not near the anal opening; it was caused by diarrhea, which led to a thrombosed internal hemorrhoid on the right side, causing the fissure.
He said it just needs to heal on its own and cannot be surgically addressed.
Now, I am unsure because it feels more painful than when I was not using the suppository, and it seems like I am back to square one.
Although it hurts, there has been no bleeding, and passing soft stools does not cause pain; it is just occasional pain after the sitz baths.
Should I consider consulting another hospital? Since I am now in the third week, I am worried that if this continues, I may never heal, as I still experience occasional pain.
Thank you, doctor!

You again hurt a lot., 40~49 year old female. Ask Date: 2016/04/29

Dr. Ke Fangxu reply Surgery

Some patients with severe anal fissures indeed cannot use suppositories.
In such cases, I would advise patients not to force it and to apply the ointment directly into the anal area instead.
Combining this with oral medication will yield better results, and warm sitz baths can also be beneficial.
However, based on your description, it seems that the anal wound may have been caused by a superficial ligation site from hemorrhoids.
If there is no improvement after three weeks, it is best to consult a colorectal specialist for further evaluation.

Reply Date: 2016/04/29

More Info

It sounds like you are experiencing significant discomfort due to a fissure or tear in the anal area, which can be quite painful and frustrating. Your experience with suppositories and the subsequent increase in pain is not uncommon, and it raises several important considerations regarding the management of anal fissures.

Firstly, it’s essential to understand that anal fissures can be quite sensitive to various forms of treatment. When you initially used the suppository, it may have caused additional irritation or trauma to the already sensitive area, leading to increased pain. This can happen for several reasons:
1. Irritation from Ingredients: Some suppositories contain ingredients that may irritate the mucosal lining of the anal canal, especially if the area is already inflamed or sensitive. If the suppository contains any active ingredients that are meant to stimulate bowel movements or provide a laxative effect, this could exacerbate the pain.

2. Physical Trauma: The act of inserting a suppository can sometimes cause physical trauma to the fissure, especially if the fissure is still healing. If the fissure is not fully healed, any additional pressure or stretching can lead to increased pain.

3. Inflammation: If the fissure is inflamed, any form of manipulation, including the use of suppositories, can lead to increased discomfort. The inflammation can make the area more sensitive to touch and pressure.

Given your experience, it seems prudent to reconsider the use of suppositories. Since you mentioned that you experienced relief with sitz baths and topical ointments, it may be beneficial to continue with those methods. Sitz baths can help soothe the area, reduce inflammation, and promote blood flow, which is essential for healing. They can also help relax the anal sphincter, making bowel movements less painful.

Here are some recommendations for managing your condition:
1. Avoid Suppositories: Since you have noticed that the suppositories increase your pain, it may be best to avoid them altogether. Focus on methods that have provided you with relief, such as sitz baths and topical treatments.

2. Dietary Adjustments: Ensure that you are consuming a high-fiber diet and staying well-hydrated. This can help soften your stools and reduce the strain during bowel movements, which is crucial for healing fissures.

3. Topical Treatments: Continue using any prescribed topical treatments that your doctor has recommended. These can help with pain relief and promote healing.

4. Follow-Up with Your Doctor: If your pain persists or worsens, it may be beneficial to seek a second opinion or follow up with your current healthcare provider. They may consider other treatment options, such as prescription medications or further diagnostic evaluations to ensure there are no underlying issues.

5. Pain Management: If the pain is significant, discuss pain management strategies with your healthcare provider. They may recommend over-the-counter pain relief options or other medications that can help manage your discomfort.

6. Monitor Symptoms: Keep track of your symptoms, including any changes in pain levels, bowel habits, or any new symptoms that may arise. This information can be helpful for your healthcare provider in determining the best course of action.

In conclusion, while anal fissures can be challenging to manage, focusing on gentle, non-invasive treatments and maintaining open communication with your healthcare provider can lead to better outcomes. If you feel that your current treatment plan is not effective, seeking a second opinion may provide you with additional insights and options for relief.

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