Managing Chronic Anal Fissures: Effective Solutions and Concerns

Recurrent anal fissures?

I have been experiencing recurrent anal fissures for almost two years now.
Each time they occur, they heal within a few days, averaging about once a month.
They usually happen when my stools are relatively large and hard, and seeing them makes me feel very upset.
I have consulted a doctor who prescribed me ointments and suppositories to use whenever I have a fissure, and he mentioned that even with surgery, there is a possibility of recurrence.
I would like to ask the doctor: 1.
Are there any methods to improve this condition? 2.
Does this count as chronic anal fissures? 3.
Is it possible to heal without surgery? (I am very afraid and do not want to undergo surgery.) 4.
Could the recurrent nature of this condition lead to any complications? Thank you.

Shun, 30~39 year old female. Ask Date: 2022/11/22

Dr. Zhang Shuhao reply Surgery

1.
The best way to improve the situation is to avoid constipation, allowing the wound to heal completely.
Increasing fluid and dietary fiber intake, taking warm sitz baths, and avoiding excessive straining during bowel movements can help.
2.
If the wound has not healed after eight weeks, it is considered a chronic anal fissure.
3.
After the wound has fully healed, maintaining good bowel habits may prevent recurrence; however, if a chronic ulcer has formed, the wound tissue may not heal on its own.
In such cases, surgical excision of the ulcer along with a sphincterotomy may be recommended.
4.
The tissue of recurrent wounds often remains in an inflammatory state, making spontaneous healing more difficult, but malignant transformation is rare.

Reply Date: 2022/11/22

More Info

Chronic anal fissures can be a frustrating and painful condition that significantly impacts quality of life. It sounds like you've been dealing with this issue for nearly two years, with episodes occurring roughly once a month. Let's address your concerns one by one.

1. Improvement Strategies: There are several strategies you can employ to help manage and potentially reduce the frequency of your anal fissures. The primary goal is to ensure that your bowel movements are soft and easy to pass. Here are some effective methods:
- Dietary Changes: Increasing your fiber intake can help soften your stool. Aim for a diet rich in fruits, vegetables, whole grains, and legumes. You might also consider fiber supplements, such as psyllium husk, to help achieve this.

- Hydration: Drinking plenty of water is crucial. Staying well-hydrated helps keep your stool soft.

- Stool Softeners: Over-the-counter stool softeners can be beneficial in preventing hard stools.

- Warm Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the area and promote healing.

- Topical Treatments: Continue using the ointments and suppositories prescribed by your doctor. These can help alleviate pain and promote healing.

- Regular Bowel Habits: Try to establish a routine for bowel movements, and avoid straining during defecation.

2. Chronic Condition: Yes, based on your description, it sounds like you are experiencing chronic anal fissures. A fissure is considered chronic if it persists for more than eight weeks or recurs frequently, as in your case.

3. Surgical Options: While surgery can be an effective treatment for chronic anal fissures, it is not the only option. Many patients find relief through conservative measures, as mentioned above. Surgical intervention, such as lateral internal sphincterotomy, is typically reserved for cases that do not respond to conservative treatments. If you are apprehensive about surgery, it's important to communicate this with your healthcare provider. They can work with you to explore all available options and help you feel more comfortable with your treatment plan.

4. Potential Complications: While chronic anal fissures can be painful and distressing, they typically do not lead to serious complications. However, if left untreated, they can lead to chronic pain, anal stenosis (narrowing of the anal canal), or the development of a fistula (an abnormal connection between the anal canal and the skin). It’s essential to manage the condition proactively to avoid these potential issues.

In summary, managing chronic anal fissures involves a combination of dietary changes, hydration, regular bowel habits, and the use of topical treatments. While surgery is an option, many patients find relief through conservative measures. If your symptoms persist or worsen, it’s crucial to follow up with your healthcare provider to discuss further options and ensure that there are no underlying issues contributing to your condition. Remember, you are not alone in this, and there are effective strategies to help you manage your symptoms and improve your quality of life.

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