Persistent Pain After Anal Fissure Surgery: Seeking Solutions

Persistent pain eight months after anal fissure surgery?

Hello Dr.
Chang, I am the person who asked question #204895.
Thank you for your response last week.
I previously inquired about a patient experiencing scar pain after anal fissure surgery.
In the past eight months since the surgery, I have consulted many doctors, and generally underwent digital examinations and anoscopy.
However, no doctor has clearly explained to me why I am experiencing pain and incontinence after the surgery, which has been quite frustrating.
The examinations also cause pain, so I can only continue to seek answers here while scheduling appointments with doctors.

Currently, my symptoms include persistent pain at the surgical scar, which lasts for about ten hours when it flares up, and I experience leakage of stool after bowel movements.
Sometimes, when my stool is softer, I have no sensation of leakage.
Therefore, I am hesitant to take magnesium oxide.

I would like to ask Dr.
Chang:
1.
Should I continue to seek medical advice to identify the cause of my scar pain and incontinence for active treatment, or should I wait a bit longer to see if it improves on its own?
2.
If the anal sphincter was injured during surgery, could this lead to issues with scarring and incontinence?
3.
The surgeon informed me that the incision at the anal opening was quite large, about three to four fingers wide.
Could this potentially cause issues with fecal retention and leakage?
4.
After surgery, I often feel the urge to have a bowel movement as soon as I wake up in the morning.
Sometimes, this happens as early as four or five in the morning, which is quite bothersome.
Could this be related to a lax sphincter?
5.
Besides sitz baths and pelvic floor exercises, are there any other methods to help soften the scar? For example, are there specific ointments or treatments that could be beneficial?
Thank you, doctor, for patiently reading my concerns.

Jiu Xiansheng, 40~49 year old female. Ask Date: 2024/01/29

Dr. Zhang Shuhao reply Surgery

1.
For issues related to scar pain and incontinence, it is advisable to first consult the surgeon regarding any potential surgical complications.
Arrange for examinations (such as ultrasound) to assess the integrity of the sphincter and determine if there are suitable medications to alleviate the symptoms.
If the original physician cannot resolve the issues, consider seeking a second opinion from another doctor.

2.
If there has been extensive resection of the sphincter, it may lead to problems with scarring and incontinence; however, such occurrences are less common with modern surgical techniques.

3.
If there was significant narrowing prior to surgery, patients may experience a sensation of incontinence postoperatively due to bowel irritability, which may take some time to adapt to.
It is important to assess sphincter function; if sphincter contraction is normal, there is a possibility for symptom improvement.

4.
Anorectal surgery does not affect intestinal motility, but symptoms of bowel irritability may exacerbate feelings of incontinence.
Short-term use of medications that suppress bowel motility may be considered.

5.
If persistent scar pain cannot be resolved, options such as steroid injections or botulinum toxin may be considered, but it is recommended to exhaust conservative treatment options before proceeding with these interventions.

Reply Date: 2024/01/29

More Info

After anal fissure surgery, persistent pain and complications such as incontinence can be distressing and significantly impact your quality of life. It’s understandable that you feel frustrated after consulting multiple doctors without receiving clear answers. Let’s address your concerns systematically.

1. Persistent Pain and Incontinence: It is crucial to continue seeking medical advice for your ongoing symptoms. Persistent pain at the surgical site could be due to several factors, including scar tissue formation, nerve damage, or even residual fissures. Incontinence, particularly if it involves leakage of stool, can be related to damage to the anal sphincter during surgery. It is advisable to consult a colorectal specialist who can provide a thorough evaluation and possibly recommend treatments such as pelvic floor therapy or further surgical options if necessary.

2. Sphincter Injury and Symptoms: Yes, if the anal sphincter was injured during surgery, it could lead to both pain and incontinence. The sphincter muscle is crucial for maintaining bowel control, and any damage can result in difficulties with stool retention. This is why a detailed assessment of the sphincter function is essential, which may include specialized tests like anal manometry.

3. Surgical Technique and Complications: The size of the incision made during surgery can indeed affect bowel control. A larger incision may lead to more significant disruption of the anal sphincter mechanism, potentially resulting in incontinence or urgency. If your surgeon indicated that a large incision was necessary, it’s important to discuss the implications of this with them, as well as any alternative techniques that could have been employed.

4. Increased Bowel Motility: The urgency you experience upon waking could be related to several factors, including diet, bowel habits, or even anxiety about incontinence. If the anal sphincter is too lax, it may not provide adequate control, leading to the sensations you describe. Consulting with a gastroenterologist may help address these gastrointestinal concerns, and they can provide dietary advice or medications to help regulate bowel movements.

5. Scar Pain Management: For the persistent pain associated with the scar, several strategies may help. Warm sitz baths can provide relief, as can topical treatments. Over-the-counter creams containing ingredients like lidocaine may help numb the area temporarily. Additionally, silicone gel sheets or silicone-based creams can be effective in softening and flattening scars over time. Some patients find relief with physical therapy focused on pelvic floor rehabilitation, which can help improve muscle tone and reduce pain.

In summary, it is essential to continue advocating for your health. Persistent symptoms after surgery warrant further investigation and possibly a multidisciplinary approach involving gastroenterologists, colorectal surgeons, and pain management specialists. Don’t hesitate to seek a second opinion if you feel your concerns are not being adequately addressed. Your well-being is paramount, and there are various avenues to explore for relief and recovery.

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