Chronic Anal Pain: Seeking Solutions for Persistent Skin Issues

Anal issues

Hello doctor, I developed severe dermatitis and fissures around the anal area a year ago due to the use of ointments, suppositories, and sitz baths, which resulted in a wound in the perineal region.
Although the skin healed after treatment, I have been experiencing pain while walking for over a year! I have consulted several hospitals, and they all said there was no wound.
Eventually, I saw a dermatologist who initially recommended applying lotion or 3M skin protectant to alleviate the pulling sensation while walking.
Recently, I returned to the dermatologist, and they noted that my skin had become very thin.
The dermatologist mentioned that the scar from the healed wound is very thin, about two centimeters long, and located in the perineal area, which makes it sensitive and prone to pulling pain.
If the skin were thicker, it could be re-stitched, but in its current state, it is more likely to tear (implying that surgery or other treatments may not be viable?).
A few months ago, I was hit by a car because I couldn't concentrate while walking due to the pain.
Perhaps the fissure was too severe at the time, as even pain relief injections in the emergency room were not effective.
I have been trying for a year, and it seems like this is how it will be going forward...
This situation makes it really difficult for me to walk for long distances, and I still cannot return to a normal life.
I have tried applying ointments, but the pain persists even after stopping the application.
I am afraid of experiencing similar side effects, so I have stopped using the ointments.
I am unsure if there are any solutions available at this stage.
I am unable to work because of this, and I am feeling increasingly helpless...

Nìmíng, 40~49 year old female. Ask Date: 2023/12/11

Dr. Ke Fangxu reply Surgery

Generally, such wounds are not sutured because they are due to skin issues rather than external trauma.
If the underlying skin problem is not resolved, the sutured area will inevitably reopen.
It is recommended that you consult a dermatologist for patient treatment of the dermatitis in the perineal area, as this issue is unlikely to be resolved through surgical means.

Reply Date: 2023/12/11

More Info

Chronic anal pain, especially following a history of skin irritation and inflammation, can be a complex issue that significantly impacts your quality of life. Given your description, it seems that you are dealing with a combination of skin sensitivity, potential nerve involvement, and possibly psychological factors related to chronic pain. Here’s a comprehensive overview of potential causes, management strategies, and recommendations for your situation.

Understanding Your Symptoms
1. Skin Sensitivity and Thinning: The skin around the anal area is delicate, and any previous trauma, such as fissures or dermatitis, can lead to long-lasting changes. If the skin has become thin and sensitive, it may not provide adequate protection against friction or pressure, leading to pain during activities like walking.

2. Nerve Sensitivity: Chronic pain can sometimes be attributed to nerve sensitization. This means that even after the initial injury has healed, the nerves in the area may remain hyper-responsive, causing pain in response to stimuli that would normally not be painful.

3. Psychological Factors: Chronic pain can lead to anxiety and stress, which can further exacerbate the perception of pain. The fear of pain can lead to altered movement patterns, which may contribute to discomfort.

Management Strategies
1. Topical Treatments: While you mentioned concerns about relying on topical medications, certain products can still be beneficial. Consider using barrier creams or ointments that contain zinc oxide or petroleum jelly to protect the area from friction and moisture. These can help reduce irritation during daily activities.

2. Moisturizing: Keeping the skin well-hydrated is crucial. Use gentle, fragrance-free moisturizers to maintain skin integrity. Look for products specifically designed for sensitive skin.

3. Avoid Irritants: Be cautious with soaps, wipes, or any products that may contain fragrances or alcohol, as these can irritate the skin further. Opt for gentle, hypoallergenic products.

4. Physical Therapy: A physical therapist specializing in pelvic floor dysfunction may help you learn techniques to reduce pain and improve mobility. They can provide exercises to strengthen the pelvic floor and improve blood flow to the area, which may aid in healing.

5. Pain Management: If the pain is severe, consider discussing pain management options with your healthcare provider. This may include medications that target nerve pain, such as gabapentin or pregabalin, which can help reduce the sensitivity of the nerves.

6. Behavioral Therapy: Cognitive-behavioral therapy (CBT) can be beneficial for managing chronic pain. It can help you develop coping strategies and reduce the psychological impact of pain.

7. Diet and Lifestyle: Maintaining a healthy diet and staying hydrated can support overall skin health. Avoiding foods that may irritate your gastrointestinal tract can also be beneficial, as digestive issues can sometimes exacerbate anal discomfort.

8. Follow-Up Care: Regular follow-ups with a healthcare provider, preferably one who specializes in pain management or dermatology, can help monitor your condition and adjust treatment plans as necessary.

When to Seek Further Help
If your symptoms persist or worsen, it may be worth seeking a second opinion or consulting a specialist in pain management or a colorectal surgeon. They can provide a more in-depth evaluation and explore other potential underlying conditions that may not have been previously considered.

Conclusion
Chronic anal pain can be a challenging condition to manage, especially when it affects your daily life and mental well-being. By employing a multi-faceted approach that includes protective measures, physical therapy, and psychological support, you may find relief and improve your quality of life. Remember, it’s essential to communicate openly with your healthcare providers about your symptoms and concerns to find the most effective treatment plan tailored to your needs.

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