Chronic Anal Fissures: Symptoms and Treatment Options - Surgery

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Chronic anal fissures are a common condition that can cause significant discomfort and pain, particularly during bowel movements. They are small tears in the lining of the anal canal, often resulting from trauma during the passage of hard stools, but they can also be exacerbated by other factors such as constipation, diarrhea, or even childbirth. Given your recent history of anal surgery and ongoing issues with chronic anal fissures, it’s understandable that you are experiencing renewed pain, especially during your menstrual period when you may not be able to take soothing measures like warm sitz baths.


Symptoms of Chronic Anal Fissures
The symptoms of chronic anal fissures can include:
- Pain during bowel movements: This is often sharp and can last for several minutes to hours after the bowel movement.

- Bleeding: While you mentioned that you haven't experienced bleeding recently, it is common for fissures to cause minor bleeding, which may appear as bright red blood on the toilet paper or in the stool.

- Itching or irritation: The area around the fissure may feel itchy or irritated.

- A visible tear: In some cases, a fissure may be visible as a small tear in the skin around the anus.


Treatment Options
1. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements. This can be achieved through dietary sources like fruits, vegetables, and whole grains, or through fiber supplements.

2. Hydration: Drinking plenty of water can help prevent constipation and promote regular bowel movements.

3. Topical Treatments: Over-the-counter creams or ointments that contain hydrocortisone or other soothing agents can help reduce inflammation and pain. Prescription medications, such as nitroglycerin ointment or calcium channel blockers, can also help relax the anal sphincter and promote healing.

4. Sitz Baths: Although you mentioned difficulty with sitz baths during your menstrual period, they are highly recommended for providing relief. Warm water can help relax the anal muscles and promote blood flow to the area, aiding in healing.

5. Botulinum Toxin Injections: In some cases, if conservative treatments fail, injections of botulinum toxin can be used to relax the anal sphincter and promote healing.

6. Surgery: If chronic fissures do not respond to conservative treatments, surgical options such as lateral internal sphincterotomy may be considered. This procedure involves cutting a small portion of the anal sphincter muscle to reduce tension and promote healing.


Concerns About Fistulas or Abscesses
You expressed concern about the possibility of developing an anal fistula or abscess. While these conditions can occur as complications of chronic fissures, they typically present with additional symptoms:
- Fistula: This is an abnormal connection between the anal canal and the skin. Symptoms may include persistent drainage of pus or stool from the skin near the anus, and sometimes pain or swelling.

- Abscess: This is a collection of pus that can cause significant pain, swelling, and redness around the anus. It may also be associated with fever.

Since you do not have visible swelling, drainage, or fever, it seems more likely that you are experiencing a flare-up of your chronic anal fissure rather than a more serious complication. However, if your symptoms worsen or if you develop new symptoms, it is crucial to consult with your healthcare provider for further evaluation and management.


Conclusion
Chronic anal fissures can be a frustrating and painful condition, but with appropriate management, many individuals find relief. It’s essential to maintain a high-fiber diet, stay hydrated, and consider topical treatments to promote healing. If symptoms persist or worsen, further evaluation by a healthcare provider may be necessary to rule out complications and discuss potential surgical options. Always consult with your physician for personalized advice and treatment plans tailored to your specific situation.