Chronic Anal Fissure Surgery: When Relief Turns into a Nightmare

Surgical intervention for anal fissures?

Hello Doctor, I have been suffering from chronic anal fissures for 2 years, and I finally underwent surgery for the fissures 3 months ago, hoping to resolve the issue once and for all.
However, the nightmare has just begun.
I had follow-up appointments for a month after the surgery until the doctor declared that I was graduated and no longer needed to return.
Currently, after 3 months, I still experience sharp pain and discomfort at the anal opening during bowel movements (even though they are soft stools), but most of the time there is no bleeding.
The tissue near the surgical incision looks red when I check in the mirror, and it hurts slightly when touched.
I pay close attention to my diet, do not smoke or drink alcohol, consume plenty of fruits and vegetables, stay well-hydrated, have soft stools, and ensure I get enough sleep without staying up late.
I have tried everything I can think of, including warm sitz baths.
I really can't think of anything else to improve my condition.
Interestingly, before the surgery, I wasn't experiencing pain with every bowel movement, but my attending physician mentioned that I had chronic anal fissures and some anal stenosis, which led me to consider surgery as a solution.
However, post-surgery, not only has the problem not been resolved, but now I experience sharp pain daily even with soft stools.
I would like to ask the doctor if this situation could indicate a surgical failure and if I should seek another physician.
I am truly overwhelmed by this issue and feel helpless...
Thank you.

Niming, 30~39 year old female. Ask Date: 2018/10/01

Dr. Ke Fangxu reply Surgery

Anal fissures are a troublesome issue, with typical symptoms including pain during bowel movements accompanied by slight bleeding.
The common causes are often constipation or diarrhea.
The fundamental treatment is to improve bowel habits, along with warm sitz baths.
Surgical treatment generally involves not only fissure excision but also sphincterotomy to address anal stenosis, resulting in three surgical sites.
Which incision are you referring to? In addition to warm sitz baths three times a day, I recommend using topical ointments and suppositories to alleviate symptoms.
If the symptoms do not improve, it is advisable to consult a physician for further evaluation and treatment.

Reply Date: 2018/10/01

More Info

Chronic anal fissures can be a debilitating condition, and it’s understandable that after undergoing surgery, you would expect significant relief. However, your experience post-surgery has been quite distressing, and it's important to address your concerns thoroughly.

Firstly, it’s crucial to understand that while surgery for chronic anal fissures, such as lateral internal sphincterotomy, is often effective, it does not guarantee complete resolution of symptoms for every patient. The fact that you are experiencing persistent pain during bowel movements, even with soft stools, suggests that there may be several factors at play.

1. Surgical Outcomes: The surgery aims to relieve the tension in the anal sphincter, which can help the fissure heal. However, if the fissure was associated with anal stenosis (narrowing of the anal canal), the surgery may not have fully addressed this underlying issue. If the anal canal remains narrowed, it could lead to discomfort during bowel movements, even if the fissure itself has healed.

2. Postoperative Pain: It’s not uncommon for patients to experience some degree of pain after surgery. This can be due to inflammation at the surgical site, which may take time to resolve. The redness and tenderness you observe near the surgical site could indicate ongoing inflammation or irritation.
3. Nerve Sensitivity: After surgery, some patients may experience heightened sensitivity in the anal area. This can lead to discomfort during bowel movements, even if there is no visible fissure or bleeding.
4. Scar Tissue Formation: Post-surgical scar tissue can sometimes lead to discomfort or pain. Scar tissue may not stretch as well as normal tissue, which could contribute to the sensation of tightness or pain during bowel movements.

5. Psychological Factors: Chronic pain can lead to anxiety and stress, which may exacerbate the perception of pain. If you are feeling overwhelmed by your symptoms, it may be beneficial to speak with a mental health professional who can help you cope with the emotional aspects of chronic pain.

Given your situation, it is advisable to consult with a colorectal specialist who can evaluate your condition further. They may recommend additional diagnostic tests, such as an anoscopy, to assess the surgical site and check for any complications, such as residual fissures, scar tissue, or other issues that may require intervention.

In the meantime, continue with your healthy lifestyle choices, such as maintaining a high-fiber diet, staying hydrated, and practicing good bowel habits. Warm sitz baths can also provide relief. If you haven’t already, consider discussing the use of topical treatments or medications that may help alleviate pain and promote healing.

In summary, while it is concerning that you are experiencing ongoing pain after surgery, it does not necessarily indicate a surgical failure. There are various factors that could be contributing to your discomfort, and a thorough evaluation by a specialist is essential to determine the best course of action. Your well-being is paramount, and seeking further medical advice is a crucial step in finding relief from your symptoms.

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