Post-Surgery Incontinence and Recovery Time After Anal Fissure Surgery

Postoperative incontinence and recovery time after anal fissure surgery?

Hello Dr.
Ke,
I previously inquired about experiencing some incontinence after my anal fissure surgery.
During my follow-up appointment, the doctor informed me that the sphincter muscle was not excised.
Instead, debridement and diamond-shaped suturing were performed at the 6 o'clock position of the fissure, along with the excision of a sentinel tag and analoplasty to enlarge my anus.
It has now been two months since the surgery, but I am still experiencing pain at the wound site.
I would like to ask the following questions:
1.
I currently have a scar at the site of the sphincter muscle.
Is it normal for scars to cause persistent mild stinging sensations and discomfort from prolonged sitting? Will scars inevitably form after surgery? How long does it typically take for scars to completely fade? I am currently using medication and taking warm sitz baths; are there any other methods to help reduce the appearance of scars?
2.
Could the scar tissue affect the elasticity of the sphincter muscle, impacting the anal closure and potentially leading to mild incontinence?
3.
Will the anal folds disappear after surgery? Will they return? If so, how long does it usually take for them to recover?
4.
What is the typical recovery time for analoplasty? Although I feel better two months post-surgery, I have not fully recovered.
Is it possible that analoplasty requires a longer recovery period?
5.
Could analoplasty lead to sphincter weakness and result in incontinence? I have been in pain for quite some time and am quite concerned, so I appreciate your valuable advice on these matters.
Thank you for your patience in reading and responding to my questions.

Jiu Xiansheng, 40~49 year old female. Ask Date: 2023/07/17

Dr. Ke Fangxu reply Surgery

1.
All surgeries will leave scars, especially if the surgical area is extensive.
Mild tingling is also normal.
The scars around the anus will typically heal completely within 1-2 months.
Due to the lack of aesthetic concerns, scar removal treatments are generally less common in this area.

2.
If the surgery did not involve cutting the sphincter muscle, then there will be no impact from scarring, and it will not cause incontinence.
However, anal plastic surgery may lead to reduced skin elasticity around the anal opening due to flap formation.

3.
Anal plastic surgery may result in the disappearance of folds, which is unlikely to recover.

4.
As mentioned earlier, it usually takes about 1-2 months for the pain to subside, during which normal bowel movements can occur, so there is no issue with recovery time.

5.
Same as point 2.

Reply Date: 2023/07/17

More Info

Post-surgery incontinence and recovery after anal fissure surgery can be a concerning issue for many patients. It is important to understand the healing process and the potential complications that may arise after such procedures. Here, I will address your questions and provide additional insights based on medical knowledge.

1. Scar Tissue and Pain: After surgery, it is common to develop scar tissue at the incision site. This scar tissue can indeed cause a sensation of mild pain or discomfort, particularly when sitting for prolonged periods. The healing process varies from person to person, but typically, scars can take several months to mature and may remain sensitive for a while. While some scars may fade over time, they may not completely disappear. The use of topical treatments, silicone gel sheets, and regular massage of the scar tissue can help improve its appearance and reduce discomfort. Additionally, warm sitz baths can provide relief and promote healing.

2. Impact of Scarring on Muscle Function: Scar tissue can potentially affect the elasticity of the anal sphincter, which may lead to issues with anal closure and contribute to mild incontinence. However, if the surgery did not involve cutting the sphincter muscle, the impact should be minimal. It is essential to follow up with your healthcare provider to assess the degree of scarring and its effect on muscle function.

3. Recovery of Anal Folds: The anal folds, or the natural wrinkles of the anal canal, may appear altered after surgery. However, they typically do recover over time. The duration for complete recovery can vary, but many patients notice improvement within a few months. If you have concerns about the appearance or function of your anal folds, discussing this with your surgeon can provide clarity.

4. Recovery Time for Anal Surgery: The recovery time after anal surgery, including anal fissure repair and analoplasty, can vary significantly based on the extent of the procedure and individual healing rates. Generally, patients may experience discomfort for several weeks, and complete recovery can take up to three months or longer. It is not uncommon for patients to still experience some discomfort or changes in bowel habits during this period.

5. Sphincter Function and Incontinence: Anal surgery can sometimes lead to temporary weakness in the anal sphincter, which may result in incontinence. This is particularly true if there was significant manipulation of the sphincter during the procedure. However, many patients find that their sphincter strength improves over time as healing progresses. If incontinence persists or worsens, it is crucial to consult your healthcare provider for further evaluation and management options.

In summary, while some discomfort and changes in bowel function are common after anal fissure surgery, most patients experience gradual improvement over time. It is essential to maintain open communication with your healthcare provider regarding your symptoms and recovery progress. They can provide tailored advice and interventions to help manage pain, improve healing, and address any concerns about incontinence. Regular follow-up appointments are vital to monitor your recovery and ensure that any complications are addressed promptly.

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