Anal Fissures and Warts: A Patient's Journey - Surgery

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Understanding anal fissures and warts can be a complex journey, especially when dealing with recurrent issues like yours. Anal fissures are small tears in the lining of the anus, often caused by trauma during bowel movements, particularly if the stool is hard or large. They can be acute (recently occurred) or chronic (lasting longer than six weeks). The pain associated with fissures can be severe, often described as a sharp or burning sensation during and after bowel movements.

In your case, it seems that you initially had an acute anal fissure, which is common and can heal on its own with proper care. However, the appearance of a small growth, which you referred to as "螅肉" (a term that may refer to a skin tag or a wart), raises some concerns. The doctor’s suggestion that you might have a viral wart (often referred to as "菜花" or condyloma acuminatum) is plausible, especially if the growth is located near the fissure. Warts are caused by the human papillomavirus (HPV) and can appear in the anal region, particularly in individuals who are sexually active.

The treatment you received, which included a topical medication (likely a form of imiquimod or another wart treatment), is common for managing warts. However, if you have not noticed any reduction in the size of the growth after two weeks, it may be worth considering further evaluation. The lack of improvement could indicate that the lesion is not a wart or that the treatment is not effective for your specific case.

You mentioned a history of internal hemorrhoids and the possibility of a skin tag or another type of growth related to your previous fissure. It is important to differentiate between these conditions because the treatment approaches can vary significantly. Skin tags, for instance, are benign and often do not require treatment unless they become symptomatic or bothersome.

Given your concerns about the potential for your fissure to become chronic, it is crucial to address both the fissure and the growth effectively. Chronic fissures can lead to ongoing pain and discomfort, and they often require more intensive treatment, such as topical nitroglycerin, calcium channel blockers, or even surgical intervention in some cases.

Here are some recommendations for your situation:
1. Follow-Up Appointment: Schedule a follow-up appointment with a colorectal specialist or a gastroenterologist. They can perform a thorough examination, possibly including a biopsy of the growth to determine its nature definitively.

2. Treatment Options: Discuss with your doctor the possibility of alternative treatments for the growth if the current topical treatment is not effective. Options may include cryotherapy, laser therapy, or surgical excision, depending on the diagnosis.

3. Fissure Management: Continue to manage your anal fissure by maintaining a high-fiber diet, staying hydrated, and using stool softeners if necessary. Warm sitz baths can also help alleviate pain and promote healing.

4. Monitor Symptoms: Keep track of any changes in your symptoms, including pain levels, bleeding, or changes in the growth. This information will be valuable for your healthcare provider.

5. Mental Health Support: Dealing with chronic pain and discomfort can take a toll on your mental health. Consider seeking support from a mental health professional if you find yourself feeling anxious or depressed about your condition.

In summary, while your initial diagnosis of an acute anal fissure is common, the development of a growth warrants further investigation. It is essential to work closely with your healthcare provider to ensure proper diagnosis and treatment, which can help prevent the fissure from becoming chronic and address any concerns regarding the growth effectively.