Post-Surgery Pain After Anal Fissure Treatment

Postoperative issues after anal fissure surgery?

Hello Dr.
Ke,
I would like to ask about my mother's condition after her anal fissure surgery.
She has had issues with hemorrhoids since she was young, and she has undergone surgery on two occasions in the past.
However, during the recent Lunar New Year, she started feeling discomfort in that area again.
She endured it until March 3rd, when she underwent minimally invasive surgery for anal fissure and hemorrhoids.
Since returning home from the hospital, she has been in constant pain.
Initially, my relatives and I thought it was normal since she had just undergone surgery, but it has now been a month, and her comfort level has not improved.

She still experiences significant pain every day and is bedridden.
Even lying down is painful for her.
Recently, she has expressed feelings of hopelessness, thinking that after the surgery, her pain would lessen, but it hasn’t, and this prolonged suffering has led her to contemplate self-harm.
As her child, it deeply saddens me to see her in such distress.

I have researched online and found that most patients experience improvement after some time post-surgery.
My mother has been attending follow-up appointments, and the doctors have mentioned that she should start feeling better after a month.
However, a month has passed, and during her check-ups, the doctor only performs a finger examination, which she finds extremely painful.
The doctor reassures her that it is normal to still be in pain and that it will improve with time.
Is this true?
As a family member, I can empathize with my mother's suffering.
She expected the surgery to alleviate some of her pain, but with her hopes dashed and the prolonged discomfort, it is understandable that she feels this way.
I would like to ask you, after one month post-anal fissure surgery, what could be the reasons for her continued pain? She has been following recommendations for sitz baths (with saline and povidone-iodine) and improving her dietary habits.
What else can we do to help alleviate her suffering?
Thank you for your time, and I sincerely seek your advice.
Thank you!

Pauline, 20~29 year old female. Ask Date: 2014/04/07

Dr. Ke Fangxu reply Surgery

Generally, pain after anal surgery decreases within two weeks and should completely heal within a month.
If pain persists after one month and is even more severe than before the surgery, it is important to consider whether the surgery itself has caused anal stenosis as a complication.
This can occur due to excessive removal of skin and soft tissue during the procedure.
If anal stenosis is confirmed, anal dilation may be necessary to improve the condition.
If anal dilation is ineffective, an analoplasty may be required to restore the elasticity and caliber of the anal opening.
However, it is essential to first determine the underlying cause of the discomfort.
I recommend consulting a different physician for further evaluation to assess whether anal stenosis is indeed the issue or if other factors are contributing to the pain.

Reply Date: 2014/04/07

More Info

Post-surgery pain after anal fissure treatment can be a distressing experience, especially when expectations for relief do not align with the reality of ongoing discomfort. Your mother’s situation is not uncommon, and understanding the potential reasons for her prolonged pain can help in managing her symptoms and improving her quality of life.

Firstly, it’s important to recognize that surgical interventions for anal fissures, including hemorrhoid treatments, can lead to significant postoperative pain. This pain can stem from several factors:
1. Surgical Trauma: The procedure itself involves cutting and manipulation of sensitive tissues, which can lead to inflammation and pain as the body heals. The healing process can take time, and while some patients may experience relief soon after surgery, others may have a more prolonged recovery.

2. Nerve Sensitivity: The anal region is rich in nerve endings. After surgery, these nerves may become hypersensitive, leading to increased pain perception. This phenomenon is known as neuropathic pain, which can persist even after the surgical site has healed.

3. Infection or Complications: Although less common, infections or complications such as abscess formation can occur post-surgery, leading to increased pain. If your mother’s pain is worsening or accompanied by other symptoms such as fever or unusual discharge, it’s crucial to consult her healthcare provider.

4. Psychological Factors: Chronic pain can also be influenced by psychological factors. Anxiety and depression can amplify the perception of pain, making it feel more intense. Your mother’s feelings of hopelessness and thoughts of self-harm are serious and warrant immediate attention from a mental health professional.

To help alleviate your mother’s pain, consider the following strategies:
1. Pain Management: Ensure that she is taking her prescribed pain medications as directed. If the current regimen is insufficient, it may be necessary to discuss alternative pain management options with her doctor. This could include stronger analgesics or adjunctive therapies such as gabapentin or pregabalin, which can help with nerve pain.

2. Warm Sitz Baths: Regular sitz baths can provide relief by soothing the area and promoting blood flow, which aids in healing. Warm water can help relax the anal sphincter and reduce pain during bowel movements.

3. Dietary Adjustments: A high-fiber diet can help soften stools and reduce straining during bowel movements, which is crucial for healing. Encourage her to drink plenty of fluids and consider using stool softeners if necessary.

4. Topical Treatments: Over-the-counter topical anesthetics or prescription creams may provide localized relief. Discuss these options with her healthcare provider.

5. Physical Therapy: In some cases, pelvic floor physical therapy can be beneficial. A trained therapist can help your mother learn techniques to relax the pelvic floor muscles, which may alleviate some of her discomfort.

6. Mental Health Support: Given her feelings of despair, it’s essential to address her mental health. Encourage her to speak with a mental health professional who can provide support and coping strategies.

7. Follow-up Care: Regular follow-ups with her surgeon or primary care physician are crucial. If her pain persists beyond what is considered normal, further evaluation may be necessary to rule out complications or to adjust her treatment plan.

In summary, while it is not uncommon for patients to experience significant pain after anal fissure surgery, persistent pain should be thoroughly evaluated. A multi-faceted approach that includes pain management, dietary changes, psychological support, and regular follow-up care can help improve your mother’s situation. It’s important to advocate for her needs and ensure she receives comprehensive care to address both her physical and emotional well-being.

Similar Q&A

Post-Surgery Concerns After Anal Fissure Surgery: Pain and Healing

Hello, I underwent a sphincterotomy on February 28 due to granulation tissue formation from an anal fissure. It has been almost two months since the surgery, and I have been taking stool softeners. However, I still experience pain near the anal opening during bowel movements, whi...

Dr. Yu Mingchang reply Surgery
Hello: It's not a big issue. Eat more vegetables and fruits. Please come back for a follow-up at the Changhua Hospital of the Ministry of Health and Welfare when you have time. We care about you.

Post-Surgery Discomfort After Anal Fissure Repair: Causes and Solutions

Hello, I had an anal fissure and underwent an internal sphincterotomy in mid-February of this year. The wound should be mostly healed by now. However, I still experience a sensation of soreness and spasms (in Taiwanese: a feeling of soreness and tightness) at the surgical site (i...

Dr. Zhang Shuhao reply Surgery
During the wound healing process, it is common to experience abnormal sensations. If a physical examination shows no signs of inflammation or infection, the standard treatment includes warm sitz baths and muscle relaxants. These abnormal sensations typically improve over time, po...

Post-Surgery Discharge After Anal Fissure Treatment: What to Expect

Dear Dr. Ko, I underwent surgery for an acute thrombosis on October 31. Less than ten days later, I developed a granulation tissue that was larger than the thrombosis itself, and it was very painful during those days. During my follow-up appointment, the doctor cut it without a...

Dr. Ke Fangxu reply Surgery
There are two different surgical methods for thrombosed hemorrhoids: incision and excision. It is unclear which one you underwent, but generally, only excision surgery can lead to the complication of granuloma. Postoperative pain may be due to anal stenosis caused by surgical sut...

Persistent Pain After Anal Fissure Surgery: Seeking Solutions

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 un...

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...