Recovery After Anal Fissure Surgery: Common Concerns and Solutions

Please inquire about the recovery situation after anal fissure surgery?

Hello Doctor, I underwent anal fissure surgery (LIS) and HET hemorrhoid coagulation surgery on February 17 of this year.
It has been two months, and I still occasionally experience some discomfort in the anal area, along with persistent discharge that is slightly yellowish-green and sometimes mixed with blood.
When I followed up with the surgeon, he mentioned that I am still in the recovery phase, and if the situation remains the same by the end of May, I may need to consider debridement.
I would like to ask:
1.
Is it common for recovery to take this long? I am feeling a bit impatient and considering consulting another doctor for alternative treatment suggestions, but I am concerned that they may not understand the surgical process and might not provide appropriate care.
Do you think it is appropriate to switch doctors?
2.
After two months post-surgery, is it possible to perform an anoscopy? I am unsure about the healing status of the wound; I have tried to feel it myself (about 1-2 finger joints deep) and did not notice any swelling.
The doctor’s digital examination also indicated that the wound is healing, but I still have ongoing discharge, which makes me very worried about potential complications.
3.
I have had multiple follow-up visits, and the doctor later prescribed Anke cream 0.1% (prednicarbate) for me to apply twice daily, but did not specify the amount to use each time.
Is this cream appropriate? Since the surgery, the doctor has prescribed various ointments: initially, a softening ointment (post-surgery), then switched to a hemorrhoid cream after a week.
Due to signs of infection, I was given the softening ointment again, and after the infection resolved, I still felt discomfort in the anal area, leading to a prescription for Yizhi Kang suppositories, until last week when I switched to Anke cream.
There are so many ointments; could you please advise me on which one would be the most suitable? Thank you.

Niming, 30~39 year old female. Ask Date: 2022/04/14

Dr. Ke Fangxu reply Surgery

1.
There have been case reports of poor wound healing associated with the use of energy devices in anal surgeries.
If you are considering changing doctors, it would be more appropriate to choose one who has experience performing such procedures.

2.
An anoscope is not necessary; an experienced physician can adequately assess the wound through digital examination alone.

3.
If there is no issue with infection, I personally recommend warm sitz baths.
Using hemorrhoid ointment is also acceptable; I tend to use steroid ointments less frequently.
It would be best to discuss this further with your surgeon.

Reply Date: 2022/04/14

More Info

Recovery after anal fissure surgery, particularly after procedures like Lateral Internal Sphincterotomy (LIS) and Hemorrhoidectomy (HET), can often be a prolonged and sometimes frustrating process. It’s not uncommon for patients to experience discomfort, discharge, and other symptoms for weeks or even months post-surgery. Let’s address your concerns one by one.

1. Duration of Recovery: It’s understandable to feel impatient about your recovery, especially when discomfort persists. Generally, recovery from anal fissure surgery can take several weeks to a few months. The healing process can vary significantly from person to person based on factors such as the extent of the surgery, individual healing capacity, and adherence to post-operative care instructions. If your surgeon has indicated that your recovery is still ongoing, it may be best to follow their guidance for now. However, if you feel that your concerns are not being adequately addressed, seeking a second opinion from another qualified surgeon can be beneficial. Just ensure that you provide them with your complete medical history and details about your surgery for the best possible advice.

2. Proctoscopy After Two Months: It is generally safe to perform a proctoscopy two months after surgery, especially if you are experiencing ongoing symptoms. This examination can provide valuable insights into the healing status of the surgical site and help identify any complications, such as infection or improper healing. If you are concerned about the discharge and discomfort, discussing the possibility of a proctoscopy with your current surgeon or a new one could help clarify your situation.

3. Topical Treatments: The use of topical medications like Anucort (hydrocortisone) can be appropriate for managing inflammation and discomfort post-surgery. However, the specific dosage and frequency of application should ideally be guided by your healthcare provider. If your doctor did not specify the amount to use, it’s reasonable to ask for clarification. In general, a small amount applied to the affected area is sufficient, but it’s crucial to follow your doctor’s recommendations closely. Given the history of infections and the various treatments you've undergone, it may be worth discussing with your doctor which topical treatment is most appropriate for your current symptoms.
In summary, while the recovery process can be lengthy and fraught with uncertainty, it’s essential to maintain open communication with your healthcare providers. If you feel that your concerns are not being addressed, seeking a second opinion can provide you with additional perspectives and potentially more effective treatment options. Remember, healing takes time, and it’s important to be patient with your body as it recovers. If you have any further questions or concerns, don’t hesitate to reach out to your healthcare provider for guidance.

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