Post-Surgery Concerns: Can Hemorrhoid Surgery Lead to Anal Fissures?

Will frequent anal fissures occur after hemorrhoid surgery?

Hello Dr.
Ke: I recently underwent two surgeries for external hemorrhoids.
The first was treated with electrocautery, and the second involved the removal of a blood clot.
Currently, there is still a small swollen area at the anal opening, but the doctor said it’s nothing to worry about.
After the second procedure, I experienced a slight anal fissure on the left side, but after taking Normacol Plus and using a topical suppository, it gradually improved.
After two weeks, the doctor advised me to stop taking it.
However, after four or five days, I noticed that my stools became increasingly hard, and yesterday they became very hard, resulting in pain on the right side of the anus similar to the previous anal fissure (originally it was on the left side).
During this period, my diet has remained normal, with plenty of fruits and vegetables.
I have a few questions:
1.
Since this time the fissure is not in the original location but rather on the opposite side, could it be that the surgeries have made the anal canal tighter, making it more prone to fissures?
2.
Is it possible that long-term use of Normacol Plus has led to a dependency, causing my stools to become harder when I stop taking it?
3.
If I need to apply a topical ointment like Hiyu Zhi, do I need to insert my finger into the anus to apply it? After soaking in warm water, the medication gets washed away, and I have to reapply it.
I’m concerned that inserting my finger might cause the fissure to reopen.
I apologize for the many questions, but after the surgeries and dealing with anal fissures, I have been in pain for a long time, and I now feel anxious about bowel movements.
Thank you, doctor, for taking the time to respond.

Niming, 20~29 year old female. Ask Date: 2017/08/23

Dr. Ke Fangxu reply Surgery

1.
Generally, hemorrhoid surgery does not cause anal fissures.
A small number of patients may experience anal stenosis due to excessive hemorrhoidal tissue or excessive skin removal during surgery, but in your case, it seems to be caused by hard stools.

2.
Normacol Plus does not cause dependency; only Dulcolax does.
If Normacol is effective, increasing dietary fiber intake will have a similar effect.

3.
Since the wound is located inside the anus, applying medication internally is more effective.
It is recommended to apply the medication before bedtime for maximum effect.
You can also use suppositories for treatment, which should also be used before bedtime.

Reply Date: 2017/08/23

More Info

Hello! Thank you for your questions regarding your post-surgery concerns after hemorrhoid surgery. It's understandable to have worries, especially after experiencing pain and complications like anal fissures. Let’s address your concerns one by one.

1. Can previous surgeries lead to tighter anal sphincters and increased risk of fissures?
Yes, it is possible that the surgeries you underwent could contribute to a tighter anal sphincter. Surgical procedures in the anal region can lead to scarring and changes in tissue elasticity, which may result in increased tension during bowel movements. This tension can make it easier for fissures to develop, especially if the stool is hard. It’s essential to maintain soft stools to reduce the risk of fissures.
2. Is there a risk of becoming dependent on stool softeners like Normacol Plus?
Long-term use of stool softeners can lead to a psychological dependency where individuals feel they cannot have a bowel movement without them. However, they do not cause the colon to lose its ability to function. It’s crucial to balance the use of stool softeners with dietary changes that promote regular bowel movements. Increasing fiber intake through fruits, vegetables, and whole grains, along with adequate hydration, can help maintain stool softness without relying solely on medications.

3. How to apply topical medications for anal fissures?
When applying topical medications like ointments for fissures, it is generally recommended to apply them externally to the affected area. If the medication requires insertion, it’s best to use a clean finger or a specialized applicator to minimize irritation. However, if you are concerned about causing further injury to the fissure, you might want to consult your doctor for specific instructions tailored to your situation. After soaking in warm water, it’s advisable to gently pat the area dry before reapplying any medication to avoid washing it away.

Additional Considerations:
- Diet and Hydration: Continue to focus on a high-fiber diet and drink plenty of fluids. This will help keep your stools soft and reduce the risk of further fissures.

- Warm Baths: Taking warm sitz baths can help soothe the area and promote healing. This practice can also help relax the anal sphincter, making bowel movements less painful.

- Follow-Up Care: Regular follow-ups with your healthcare provider are essential. If you notice persistent pain or if the fissures do not heal, further evaluation may be necessary. Your doctor may recommend additional treatments or interventions if conservative measures do not provide relief.

In conclusion, while hemorrhoid surgery can lead to complications such as anal fissures, understanding how to manage your symptoms and maintain a healthy bowel routine is crucial. Don’t hesitate to reach out to your healthcare provider for personalized advice and support as you navigate your recovery. Your comfort and health are paramount, and they can help you find the best path forward. Wishing you a smooth recovery!

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