Managing Anal Pain: Fissures and Hemorrhoids - Surgery

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Managing anal pain, particularly when it involves conditions such as anal fissures and hemorrhoids, can be quite challenging and distressing. Based on your description, it seems you have been dealing with a complex situation that includes a history of anal fissures, ongoing pain, and the presence of hemorrhoids. Let's break down the potential causes of your symptoms and explore some management strategies.


Understanding Anal Fissures and Hemorrhoids
Anal Fissures are small tears in the lining of the anus, often caused by passing hard stools or straining during bowel movements. Symptoms typically include sharp pain during and after bowel movements, which may be accompanied by bleeding. It sounds like you experienced this initially, and while the bleeding has stopped, the pain persists, which can be indicative of ongoing irritation or a new fissure.

Hemorrhoids, on the other hand, are swollen veins in the lower rectum and anus. They can be internal or external and may cause discomfort, itching, and bleeding. The fact that you mentioned needing to push them back in suggests you may be dealing with external hemorrhoids, which can exacerbate pain, especially when sitting or during bowel movements.


Current Symptoms
You mentioned that you are experiencing persistent pain after bowel movements, a sensation of broken skin on the left side of the anal area, and discomfort when sitting or touching the area. These symptoms could indicate several issues:
1. Recurrent Fissure: Even if you are not experiencing bleeding, a fissure can still be present and cause significant pain.

2. Hemorrhoidal Complications: The presence of hemorrhoids can lead to increased sensitivity and pain, especially if they are inflamed or thrombosed (clotted).

3. Muscle Spasms: The anal sphincter may be spasming in response to pain, which can further exacerbate discomfort and create a cycle of pain and tension.


Management Strategies
1. Dietary Adjustments: Ensure you are consuming a high-fiber diet to keep stools soft. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Consider using a fiber supplement if necessary.

2. Hydration: Continue to drink plenty of fluids, as you are already doing. Aim for at least 2 liters of water daily to help prevent constipation.

3. Sitz Baths: Regular sitz baths in warm water can help soothe the area and promote healing. Aim for 10-15 minutes, several times a day, especially after bowel movements.

4. Topical Treatments: Over-the-counter creams containing hydrocortisone can help reduce inflammation and pain. Additionally, topical anesthetics like lidocaine may provide temporary relief.

5. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation. However, consult with a healthcare provider before starting any new medication.

6. Avoid Straining: When using the bathroom, try to relax and avoid straining. If you feel the urge to push, take a moment to breathe and allow your body to naturally expel the stool.

7. Pelvic Floor Exercises: Gentle pelvic floor exercises may help relax the anal sphincter and reduce spasms.

8. Consult a Specialist: If your symptoms persist despite these measures, it may be time to consult a gastroenterologist or a colorectal surgeon. They can perform a thorough examination and may suggest treatments such as prescription medications, rubber band ligation for hemorrhoids, or even surgical options if necessary.


Conclusion
It’s important to address both the fissures and hemorrhoids to alleviate your pain effectively. While home management strategies can be beneficial, persistent symptoms warrant professional evaluation to rule out any complications and to explore more targeted treatments. Remember, you are not alone in this, and seeking help is a crucial step towards recovery.