Struggling with Hemorrhoids and Anal Fissures: Is Surgery the Only Solution?

Due to prolonged sitting on the toilet because of constipation, there is a noticeable external hemorrhoid?

About 1-2 years ago, I had a hot pot meal with seafood that wasn't fresh, and after an all-you-can-eat experience, I ended up with diarrhea for several days.
At that time, the severity of my anal fissure was so bad that it resembled a heavy menstrual bleed, and there were still blood traces left in the toilet after flushing.
Now, whenever I exert myself too much or wipe too hard, I frequently experience anal fissures.
Currently, I am taking weight loss medication and drinking a lot of water, but my constipation has become increasingly severe.
I spend more and more time on the toilet, and to avoid straining, I sometimes have to use my hands to assist.
My stools are small, hard, and infrequent, and sometimes I feel like the sweat under my arms has a fecal odor.
I have visible external hemorrhoids that have protruded, about the size of a 5 to 10 NT dollar coin, and it seems they are getting larger.
The anal opening feels like it's collapsing, and even passing gas feels difficult.
After struggling on the toilet for the past two days, my anus feels painful, burning, and itchy, but I haven't seen any blood on the toilet paper.
Is surgery the only option left for improvement? Will the anal sphincter relax after surgical removal?

Wo shi nv hai er, 20~29 year old female. Ask Date: 2016/09/20

Dr. Ke Fangxu reply Surgery

This situation likely indicates a higher possibility of hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on bowel movements.
Warm sitz baths may also help alleviate symptoms.
You can purchase hemorrhoid suppositories at the pharmacy for use.
It is best not to take stool softeners indiscriminately; at this age, increasing dietary fiber and hydration should be sufficient.
If bleeding persists, it is important to consult a physician to evaluate the necessity of surgery.
Surgical removal will not cause relaxation of the sphincter; this is a misconception that has been perpetuated.

Reply Date: 2016/09/20

More Info

Dealing with hemorrhoids and anal fissures can be incredibly uncomfortable and distressing, especially when they lead to severe pain and bleeding. Your description indicates that you have been experiencing significant issues, including recurrent anal fissures and external hemorrhoids, which can be exacerbated by constipation and straining during bowel movements.
First, it’s essential to understand that while surgery is one option for treating severe hemorrhoids and fissures, it is not the only solution. Many patients can find relief through conservative management strategies, which should be the first line of treatment. Here are some approaches you might consider:
1. Dietary Changes: Increasing your fiber intake is crucial. A diet rich in fruits, vegetables, whole grains, and legumes can help soften your stool and make bowel movements easier. You might also consider fiber supplements, such as psyllium husk, to help achieve the recommended daily intake of fiber (25-30 grams).

2. Hydration: Drinking plenty of water is vital. Aim for at least 8-10 glasses of water a day to help prevent constipation. Proper hydration can help keep your stool soft and easier to pass.

3. Stool Softeners: Over-the-counter stool softeners can be beneficial, especially if you are experiencing hard stools. These medications can help reduce straining during bowel movements.

4. Sitz Baths: Taking warm sitz baths several times a day, especially after bowel movements, can help soothe the anal area and promote healing. This practice can also help reduce inflammation and discomfort.

5. Topical Treatments: Over-the-counter creams or ointments that contain hydrocortisone or witch hazel can provide temporary relief from itching and discomfort associated with hemorrhoids.
6. Avoid Straining: It’s crucial to avoid straining during bowel movements. If you feel the urge to go, try to respond promptly rather than waiting, as this can lead to harder stools.

7. Regular Exercise: Engaging in regular physical activity can help stimulate bowel function and reduce the risk of constipation.

If conservative measures fail to provide relief and your symptoms persist or worsen, surgical options may be considered. Surgical procedures for hemorrhoids include hemorrhoidectomy (removal of hemorrhoids) and stapled hemorrhoidopexy. These procedures can be effective, but they do come with risks, including potential complications such as infection, bleeding, and changes in bowel habits.

Regarding your concern about the potential for anal sphincter laxity after surgery, it is important to discuss this with your surgeon. While surgical techniques have improved, and many patients do not experience significant changes in sphincter function, there is always a risk of complications. Your surgeon will be able to provide you with information specific to your case and help you weigh the risks and benefits of surgery versus continued conservative management.

In conclusion, while surgery is a viable option for treating severe hemorrhoids and anal fissures, it is not the only solution. A combination of dietary changes, hydration, stool softeners, topical treatments, and lifestyle modifications can often provide significant relief. If these measures do not work, consulting with a colorectal surgeon can help you explore surgical options and determine the best course of action for your specific situation. Remember, it’s essential to communicate openly with your healthcare provider about your symptoms and concerns to find the most appropriate treatment plan for you.

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