Do You Really Need Surgery for Chronic Anal Fissures and Fistulas? - Surgery

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Is surgery necessary for chronic anal fissures and fistulas?


I have internal and external hemorrhoids and recently underwent a colon resection.
A month later, after receiving the AZ vaccine, I experienced abdominal pain and the urge to use the restroom every hour, but I couldn't have a bowel movement.
Later, I felt pain in my rectum and had a sensation of incomplete evacuation.
Upon follow-up, the doctor diagnosed me with internal and external hemorrhoids, anal fissures, and a fistula, recommending immediate traditional surgery.
Since I wanted to consider my options, the doctor prescribed pain relief and anti-inflammatory medication along with a topical ointment, which helped eliminate blood in my stool, but I still experience pain during bowel movements and significant pain during digital examination.
I would like to ask:
1.
I have been taking stool softeners; could this be causing my persistent urge to use the restroom (possibly bowel urgency)? Sometimes, I don't feel an urgent need but hold it in due to fear of pain, only going twice a day in the morning and evening.
Is this okay?
2.
If I opt for surgery to address the internal and external hemorrhoids, anal fissures, and fistula, is traditional surgery the only option? How long does the surgery typically take? Will I be conscious during the procedure? What is the expected recovery time, and how long should I take off work to rest at home?
3.
If I am no longer experiencing blood in my stool and only have pain during bowel movements after taking pain medication, is surgery absolutely necessary? Could soaking in warm water be sufficient for healing?
4.
Should I avoid scheduling the surgery around my menstrual period?

gg, 40~49 year old female. Ask Date: 2021/07/06

Dr. Ke Fangxu reply Surgery


1.
Taking laxatives can indeed lead to excessive bowel movements.
If this occurs, it is advisable to stop the medication and see if the symptoms improve.
Holding in bowel movements is not a good habit, as continuous anal contractions can worsen the symptoms of anal fissures.
It is recommended to respond to the urge to defecate but to shorten the time spent on the toilet.
2.
If these issues are present simultaneously, traditional surgery is the only option.
Anesthesia can be classified into two types: intravenous sedation and regional anesthesia.
The former results in loss of consciousness, while the latter allows the patient to remain awake.
Post-operative pain at the incision site typically lasts about 1-2 weeks, with complete healing taking 2-4 weeks, depending on the severity of the anal fistula.
Generally, a week of rest is sufficient.
3.
If there is no bleeding or signs of infection, and the pain is manageable, it is possible to delay surgery without jeopardizing health; however, symptoms may recur.
4.
The surgery itself does not have adverse effects, but it is still recommended to avoid certain activities to prevent complications that could hinder the ability to perform warm water sitz baths post-operatively.

Reply Date: 2021/07/06

More Info


When dealing with chronic anal fissures and fistulas, the decision to undergo surgery can be quite complex, especially considering your recent medical history and current symptoms. Let's break down your concerns and provide some insights based on medical knowledge.

1. Softener Use and Bowel Habits: You mentioned taking stool softeners and experiencing a persistent urge to have bowel movements. Stool softeners are generally safe and can help prevent straining, which is crucial for healing fissures. However, if you're feeling an excessive urge to go, it might be due to a combination of factors, including anxiety about pain during bowel movements or the effects of the softeners. It's important to listen to your body; going twice a day is generally acceptable, but if you're feeling uncomfortable or if the urge is overwhelming, it may be worth discussing with your doctor. You should aim for regular bowel movements without straining, which can exacerbate fissures.

2. Surgical Options: If your doctor has recommended surgery for your internal and external hemorrhoids, anal fissures, and fistula, it’s likely because conservative treatments have not provided sufficient relief. Traditional surgery for these conditions can vary in duration but typically lasts about 30 minutes to an hour. During the procedure, you will likely be under anesthesia, so you won't be aware of the surgery itself. Recovery times can vary; many patients can return to normal activities within a week or two, but complete healing may take longer, especially if you have multiple procedures done at once. It's advisable to discuss your specific recovery timeline with your surgeon.

3. Conservative Management: If your symptoms have improved with pain medication and topical treatments, you might wonder if surgery is necessary. While some patients find relief with conservative measures like warm sitz baths, dietary changes, and topical treatments, surgery may still be the best option if you have persistent pain or if the fissures and fistulas do not heal. Surgery can provide a more definitive solution, especially if there is a risk of complications from untreated conditions.

4. Timing of Surgery: Regarding your menstrual cycle, it is generally advisable to schedule surgery when you are not menstruating. This is primarily for comfort, as menstrual cramps can complicate recovery and add to discomfort post-surgery. However, if your symptoms are severe, your surgeon may still proceed with the surgery.

In conclusion, while surgery can seem daunting, it may be the most effective way to address your chronic anal fissures and fistulas, especially if conservative treatments have not provided lasting relief. It’s essential to have a thorough discussion with your healthcare provider about the risks and benefits of surgery versus continued conservative management. They can help you weigh your options based on your specific circumstances, including your pain levels, the severity of your conditions, and your overall health. Remember, the goal is to achieve a pain-free and healthy bowel function, so don’t hesitate to seek a second opinion if you feel uncertain about the recommended course of action.

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