Chronic anal fissure
Hello Dr.
Ke, I had surgery for chronic anal fissure last November.
After the surgery, I no longer experience pain during bowel movements, but I still have bleeding.
During my follow-up visit, the doctor mentioned that the wound needs further repair, so I underwent another surgery in August this year.
However, up to now, I still have bleeding during bowel movements (without pain).
I would like to ask how I can improve the bleeding situation.
Thank you.
Bo, 30~39 year old female. Ask Date: 2016/09/14
Dr. Ke Fangxu reply Surgery
After anal fissure surgery, if there is no pain, it generally indicates that the surgical objectives have been achieved.
However, if there is still bleeding, it may be due to the surgical wound not being fully healed.
It is recommended to enhance sitz baths and topical medication treatment.
If the bleeding persists without improvement, it is advisable to consult the surgeon for further evaluation.
Reply Date: 2016/09/14
More Info
Managing chronic anal fissures can be a challenging process, especially when surgery has been performed but bleeding persists. It’s important to understand that while surgery can alleviate pain and promote healing, it does not always guarantee that bleeding will cease completely. Here are some insights and recommendations based on your situation.
Understanding Chronic Anal Fissures
Chronic anal fissures are tears in the lining of the anal canal that can cause significant discomfort and bleeding. They often result from trauma during bowel movements, particularly in individuals who experience constipation or have hard stools. Surgical intervention, such as lateral internal sphincterotomy, is often performed to relieve tension in the anal sphincter and promote healing.
Post-Surgical Bleeding
The fact that you are experiencing bleeding after your second surgery, despite the absence of pain during bowel movements, suggests that there may be several underlying factors at play:
1. Incomplete Healing: The surgical site may not have healed completely, leading to ongoing bleeding. This can be exacerbated by factors such as straining during bowel movements or inadequate stool softening.
2. Scar Tissue Formation: After surgery, scar tissue can form, which may lead to new fissures or irritation in the area, causing bleeding.
3. Underlying Conditions: Conditions such as inflammatory bowel disease (IBD) or infections can also contribute to persistent bleeding.
Recommendations for Management
1. Dietary Modifications: Ensure that your diet is high in fiber to promote softer stools. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Additionally, consider using a fiber supplement if necessary.
2. Hydration: Drink plenty of water throughout the day to help keep stools soft and prevent constipation.
3. Stool Softeners: Over-the-counter stool softeners can be beneficial in preventing straining during bowel movements. Consult your physician about the appropriate options for you.
4. Sitz Baths: Regular sitz baths (soaking the anal area in warm water) can help soothe the area, promote blood flow, and aid in healing. Aim for 10-15 minutes a few times a day, especially after bowel movements.
5. Topical Treatments: Your doctor may recommend topical treatments, such as nitroglycerin ointment or calcium channel blockers, to help relax the anal sphincter and promote healing.
6. Follow-Up Appointments: It is crucial to maintain regular follow-up appointments with your healthcare provider. If bleeding persists, further evaluation may be necessary to rule out other causes or to consider additional interventions.
7. Avoid Straining: When using the bathroom, avoid straining. If you feel the need to push, consider using a stool softener or laxative to ease the process.
8. Physical Activity: Regular physical activity can help promote bowel regularity and prevent constipation.
When to Seek Further Help
If the bleeding continues despite these measures, or if you notice any changes in the nature of the bleeding (such as increased volume or changes in color), it is essential to contact your healthcare provider. They may need to perform additional examinations, such as an anoscopy or colonoscopy, to assess the surgical site and surrounding tissues.
Conclusion
Chronic anal fissures can be a persistent issue, and while surgery can significantly improve symptoms, ongoing management is often necessary. By implementing dietary changes, maintaining hydration, and following your doctor's recommendations, you can help improve your condition. Always keep an open line of communication with your healthcare provider to ensure that any complications are addressed promptly.
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