Chronic Constipation and Dependence on Laxatives: Seeking Surgical Solutions

Difficulty in bowel movements, long-term use of laxatives?

Hello, doctor.
I have been experiencing recurrent anal fissures for the past five years, approximately once a month.
The pain usually subsides after about a week, but I have been consistently applying ointment (because my anus feels uncomfortable without it).
Now, I have been using it for almost five years, and I feel increasingly unable to tolerate hard stools; even banana-shaped stools can cause me to re-injure myself.
Therefore, I started taking traditional Chinese medicine four years ago, which has been quite effective.
However, I am concerned about the long-term use of traditional Chinese medicine and its potential link to colon cancer.
Other dietary supplements do not seem to work as well as traditional Chinese medicine.
I would like to ask the doctor if surgery would be recommended in my situation.
What methods can help make my anus less fragile?

Pei-Chen, 30~39 year old female. Ask Date: 2023/10/04

Dr. Zhang Shuhao reply Surgery

1.
The use of topical ointments containing steroids for an extended period can make the mucous membranes more susceptible to injury and wounds may heal more slowly; it is recommended to use them in a phased manner.
2.
Traditional Chinese medicine prescribed by a licensed practitioner generally does not increase the risk of colorectal cancer, but it is important to discuss the specific effects with your doctor.
3.
Surgery for anal fissures includes chronic ulcer excision and sphincterotomy; if the anal fissure is causing significant discomfort, surgical intervention may be considered, and an evaluation can be done at a colorectal clinic.

Reply Date: 2023/10/04

More Info

Chronic constipation and recurrent anal fissures can be quite distressing and significantly impact your quality of life. Given your history of anal fissures and reliance on topical medications and traditional Chinese medicine, it’s understandable that you are seeking a more permanent solution.
Firstly, it’s important to recognize that chronic constipation can lead to anal fissures due to the strain during bowel movements. When hard stools pass through the anal canal, they can cause tears in the delicate skin, leading to pain and further complications. Your experience of recurrent fissures, even with softer stools, suggests that your anal sphincter may be overly tight or that there may be other underlying issues contributing to your symptoms.

Surgical Options
1. Lateral Internal Sphincterotomy: This is a common surgical procedure for chronic anal fissures. It involves cutting a portion of the internal anal sphincter muscle to relieve tension and allow the fissure to heal. This procedure has a high success rate and can significantly reduce pain and recurrence of fissures.

2. Fissurectomy: This involves the surgical removal of the fissure and surrounding scar tissue. It can be performed in conjunction with sphincterotomy to enhance healing.

3. Botulinum Toxin Injection: In some cases, botulinum toxin can be injected into the anal sphincter to temporarily paralyze the muscle, reducing spasm and allowing the fissure to heal without the need for invasive surgery.

Non-Surgical Management
Before considering surgery, it’s essential to explore non-surgical management options:
- Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools. Adequate hydration is also crucial. Consider consulting a dietitian for personalized advice.

- Stool Softeners: Over-the-counter stool softeners can help ease bowel movements and reduce strain.

- Regular Bowel Habits: Establishing a routine for bowel movements can help train your body to have regular, softer stools.

- Pelvic Floor Therapy: Sometimes, pelvic floor dysfunction can contribute to constipation and anal fissures. A physical therapist specializing in pelvic health can provide exercises and techniques to improve muscle coordination and relaxation.

Concerns About Long-Term Use of Traditional Medicine
Regarding your concern about the long-term use of traditional Chinese medicine and its potential link to colorectal cancer, it’s essential to consult with a healthcare professional who can evaluate the specific herbs and formulations you are using. While some herbal remedies can be beneficial, others may have side effects or interactions that could pose risks. Regular screening for colorectal cancer is recommended, especially if you have a history of gastrointestinal issues.

Conclusion
In summary, while surgery can be an effective solution for chronic anal fissures and constipation, it’s essential to weigh the benefits and risks with your healthcare provider. Non-surgical management strategies should also be explored to improve your bowel health and reduce the recurrence of fissures. Consulting with a colorectal surgeon or a gastroenterologist can provide you with tailored advice and help you make an informed decision about your treatment options. Remember, addressing the underlying causes of your symptoms is crucial for long-term relief and improved quality of life.

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