Managing Post-Surgical Scar Indentation and Pain: Solutions and Insights

Depression of the perianal skin after healing?

Previously, I had an anal fissure that led to prolonged sitz baths and the use of hemorrhoid ointments for several months, which resulted in severe dermatitis and skin breakdown.
When I visited the hospital, they advised me to discontinue use and prescribed zinc oxide, which I applied for about ten days until it healed.
However, it left a noticeable depressed scar! Now, I experience pulling sensations and pain when walking or climbing stairs, and sometimes sitting causes pressure and pain as well.
Riding a motorcycle is even more difficult! The hospital stated that it has already healed, and applying anything further would not be beneficial, so I have not used any ointments for two months (including zinc oxide...
applying zinc oxide made it dry, making it impossible to walk).
I would like to ask if this scar will permanently affect my life and make normal activities difficult, or if there are any medical options available for treatment.
The hospital mentioned that the external wound cannot be surgically addressed, especially since it has healed, so there is no need for further surgery.
I have been troubled for a long time and do not know what to do to restore my normal activities; I feel very sad! Now, I mostly lie flat or on my side...

Niming, 40~49 year old female. Ask Date: 2023/01/01

Dr. Ke Fangxu reply Surgery

In theory, once an anal fissure heals, there should be no pain unless it is due to pre-existing chronic fissures caused by excessive sphincter contraction.
If the pain is intolerable and affects daily activities, one can try using rectal suppositories for a period of time.
Otherwise, surgery may be the only option to improve the current condition.

Reply Date: 2023/01/01

More Info

Managing post-surgical scar indentation and pain can be a challenging and frustrating experience, especially when it significantly impacts your daily activities and quality of life. Based on your description, it seems that you have developed a noticeable scar after treatment for anal fissures, which has led to discomfort and pain during activities such as walking, climbing stairs, and even sitting. Here are some insights and potential solutions to help manage your situation.

Understanding Scar Formation
Scars form as part of the body’s natural healing process after an injury or surgery. When the skin heals, it may not return to its original state, leading to various types of scars, including hypertrophic scars, keloids, and atrophic scars (which are indented). The indentation you are experiencing could be due to the way the tissue healed, possibly influenced by factors such as the depth of the injury, the tension on the skin during healing, and individual skin characteristics.

Pain Management Strategies
1. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can provide exercises to improve flexibility and strength in the surrounding muscles, which may help alleviate some of the discomfort associated with the scar. They can also teach you techniques to manage pain and improve your range of motion.

2. Scar Massage: Although your healthcare provider mentioned that applying ointments may not help, gentle massage of the scar tissue can promote blood flow and may help soften the scar over time. Use a moisturizing lotion or oil to reduce friction during the massage.

3. Silicone Gel Sheets or Silicone Gel: These products are often recommended for scar management. They can help flatten and soften scars over time. While your healthcare provider may have indicated that the scar is fully healed, these products can still be used to improve the appearance and texture of the scar.

4. Pain Relief Medications: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain. If the pain is severe, discussing prescription options with your doctor may be necessary.

5. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture or chiropractic care. While evidence varies, these therapies may provide some individuals with pain relief.

Medical Interventions
If conservative measures do not provide relief, there are several medical interventions that can be considered:
1. Corticosteroid Injections: These can help reduce inflammation and pain associated with scar tissue. They may also help flatten raised scars.

2. Laser Therapy: Laser treatments can improve the appearance of scars and may help with pain management. This therapy works by promoting collagen remodeling in the scar tissue.

3. Microneedling: This technique involves using fine needles to create micro-injuries in the skin, which can stimulate collagen production and improve the texture of the scar.

4. Surgical Revision: In some cases, surgical options may be considered to revise the scar. However, this is typically a last resort and should be discussed thoroughly with a qualified surgeon.

Psychological Support
Living with chronic pain and the impact of a scar can take a toll on mental health. Consider seeking support from a mental health professional or joining a support group for individuals dealing with similar issues. Cognitive-behavioral therapy (CBT) can be particularly effective in managing chronic pain and improving coping strategies.

Conclusion
While it may feel discouraging to hear that your scar is fully healed and that further surgical intervention is not recommended, there are still various strategies you can explore to manage pain and improve your quality of life. Engaging with healthcare professionals who specialize in pain management and scar treatment can provide you with tailored solutions. Remember, it’s essential to advocate for your health and seek multiple opinions if necessary. Your comfort and ability to engage in daily activities are paramount, and there are pathways to help you achieve that.

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