Managing Pain and Incontinence After Anal Fissure Surgery: A Patient's Journey

Postoperative pain and incontinence after anal fissure surgery?

Hello Dr.
Ke, last May I underwent surgery for chronic anal fissures combined with anal stenosis.
The doctor performed excision of internal hemorrhoids, sentinel hemorrhoids, fissurectomy, and a vertical and horizontal suture.
It has been about 10 months since the surgery, and I still experience daily pain and incontinence.
I have consulted many doctors and truly do not know what to do next, so I would like to seek your advice.
1.
The pain from the surgery has significantly decreased and I have recovered a lot, but when I have soft stools, the scar area becomes sharp and painful for several hours afterward, although there is no bleeding.
Is this scar pain, or does it indicate that the wound has not yet healed? Will it be like this for the rest of my life? The pain from hard stools was severe, but it has improved recently.
2.
After using the bathroom, I involuntarily leak stool for about 10 minutes, which requires me to wash frequently.
Sometimes, when the stool is soft, it becomes worse.
Most doctors say that the sphincter is still functional, while others suggest that the shape of the anal canal has been altered due to the excision of the posterior sphincter.
Is there a chance for this incontinence to recover? Typically, isn't the lateral internal sphincter the one that gets cut? Are there still surgeries that involve excising the posterior sphincter? What further surgeries do I need to undergo to recover? Could you provide me with some advice and direction? Are there any recommended doctors in Taoyuan or Taipei? I feel very helpless—I have seen over ten doctors without receiving clear treatment options, and it is very difficult to live normally.
Thank you for patiently reading my questions.

Jiu Xiansheng, 40~49 year old female. Ask Date: 2024/02/29

Dr. Ke Fangxu reply Surgery

1.
If the pain during bowel movements decreases and there is no more bleeding, then the surgery should be considered successful.
The scar pain should gradually alleviate; however, if it persists for more than six months, it is advisable to consult the surgeon for further evaluation.

2.
The term "keyhole deformity" refers to the deformation of the anus caused by damage to the posterior anal sphincter, which typically occurs in patients who have undergone fistula surgery.
This phenomenon is less common in patients who have had anal fissure surgery.
However, if there is insufficient contraction strength of the sphincter, mild incontinence may occur.
Generally, oral medications combined with Kegel exercises are attempted first to see if there is any improvement.
Biofeedback therapy and electrical stimulation are also options.
If conservative treatments are ineffective, it is recommended to perform anal manometry, and surgical intervention such as sphincteroplasty may be necessary to reinforce the deficient area.
However, if a large-scale surgery was performed previously, the difficulty of a subsequent surgery is significantly increased.

Reply Date: 2024/02/29

More Info

Managing pain and incontinence after anal fissure surgery can be a challenging journey, especially when the symptoms persist long after the procedure. It’s understandable that you feel frustrated after consulting multiple doctors without finding a clear path forward. Let's break down your concerns and explore potential avenues for improvement.

1. Post-Surgical Pain: It’s common for patients to experience pain at the surgical site for an extended period after anal fissure surgery. The sharp pain you feel after bowel movements, particularly with soft stools, could be attributed to scar tissue or nerve sensitivity in the area. This phenomenon is often referred to as "scar pain," which can occur as the body heals and the nerves in the area become more sensitive. While it’s encouraging that your overall pain has decreased, the lingering discomfort may take time to resolve. It’s not unusual for some patients to experience discomfort for several months post-surgery, and in some cases, it can persist longer. However, it’s essential to monitor this pain; if it worsens or is accompanied by other symptoms, further evaluation may be necessary.

2. Incontinence Issues: The involuntary leakage of stool you describe is understandably distressing. This condition can arise from several factors, including damage to the anal sphincter during surgery, changes in the anatomy of the anal canal, or even nerve damage. The fact that some doctors have suggested that your sphincter is still functional while others attribute the issue to surgical changes indicates a need for a comprehensive assessment.
The key here is to determine the exact cause of your incontinence. If the surgery involved significant alterations to the anal sphincter or surrounding structures, it might have led to changes that affect bowel control. In some cases, patients may benefit from pelvic floor rehabilitation, which can help strengthen the muscles involved in bowel control.
If conservative measures do not yield improvement, surgical options may still be available. Some procedures can help restore function to the anal sphincter, such as sphincteroplasty or other reconstructive techniques. It’s crucial to discuss these options with a colorectal surgeon who specializes in functional bowel disorders.

3. Next Steps: Given your ongoing symptoms, it may be beneficial to seek a second opinion from a colorectal surgeon who has experience with complex cases of anal fissure surgery and its complications. Look for a specialist who is affiliated with a reputable medical center or academic institution, as they may have access to the latest treatment options and a multidisciplinary team that can address your concerns holistically.

4. Recommendations for Specialists: While I cannot provide specific names of doctors in Taoyuan or Taipei, I recommend looking for colorectal surgeons who are board-certified and have a strong focus on pelvic floor disorders. You might also consider reaching out to local support groups or online forums where patients share their experiences and recommendations for specialists.

5. Lifestyle and Home Care: In the meantime, managing your bowel habits can also help alleviate some discomfort. Ensuring a high-fiber diet, staying hydrated, and possibly using stool softeners can help reduce strain during bowel movements. Additionally, warm sitz baths may provide relief and promote healing in the anal area.

In conclusion, while your journey has been difficult, there are still options available for managing your pain and incontinence. It’s essential to continue advocating for your health and seeking out specialists who can provide the care you need. Remember, healing takes time, and with the right support and treatment, you can work towards regaining a more comfortable and normal life.

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