Surgery for Chronic Anal Fissures and Hemorrhoids

Anal fissure surgery issues?

Hello, doctor.
I previously visited a large hospital where the doctor diagnosed me with chronic anal fissure.
Although surgery was not highly recommended, I was advised that if my symptoms do not improve, surgery might be necessary.
Recently, I have experienced a recurrence (each bowel movement feels like a knife cutting, whether I am constipated, have diarrhea, or have soft stools; the pain persists for several hours after bowel movements, and sometimes even painkillers do not alleviate the pain, causing me to break out in a cold sweat).
Therefore, I am considering surgery, but I still feel very anxious about it.
I also have both internal and external hemorrhoids, and recently, due to the recurrence of the fissure, I have noticed signs of my internal hemorrhoids protruding.

Can both the internal and external hemorrhoids be addressed during the same surgery? What are the potential postoperative complications? Is the recurrence rate for anal fissures and hemorrhoids high after surgery? The doctor mentioned that the surgery would require a three-day hospital stay followed by a week of recovery.
I would like to know if I can manage my own wound care and medication after surgery, or is it better to have family assistance? I apologize for the trouble.

Duiyu shoushu you dian haipa, 20~29 year old female. Ask Date: 2015/07/27

Dr. Ke Fangxu reply Surgery

1.
If an anal fissure is accompanied by internal and external hemorrhoids, they are generally excised together.

2.
Post-surgery, there are typically no severe complications aside from pain and minor bleeding.

3.
If bowel habits and dietary practices are irregular, symptoms may recur as soon as 1-2 years after surgery.

4.
There is no need for special dressing changes after surgery; simply taking warm sitz baths is sufficient, and generally, no special assistance from family members is required.

Reply Date: 2015/07/27

More Info

Understanding surgery for chronic anal fissures and hemorrhoids can be a daunting prospect, especially when dealing with persistent pain and discomfort. Chronic anal fissures are small tears in the lining of the anus, often caused by trauma during bowel movements, which can lead to significant pain, especially during and after defecation. Hemorrhoids, on the other hand, are swollen veins in the lower rectum and anus that can cause discomfort, bleeding, and itching.

When conservative treatments such as dietary changes, stool softeners, topical medications, and pain relief do not alleviate symptoms, surgery may be considered. The surgical options for chronic anal fissures typically include lateral internal sphincterotomy, which involves cutting a portion of the anal sphincter muscle to relieve tension and promote healing. For hemorrhoids, procedures can range from rubber band ligation to hemorrhoidectomy, depending on the severity and type of hemorrhoids present.

In your case, since you have both chronic anal fissures and internal hemorrhoids, it is indeed possible to address both conditions in a single surgical procedure. This can be beneficial as it minimizes the need for multiple surgeries and allows for a more comprehensive treatment of your symptoms.

Regarding your concerns about postoperative complications, it is essential to understand that while surgery can significantly improve symptoms, there are potential risks involved. Common complications may include:
1. Pain: Postoperative pain is common, but it can usually be managed with medications.

2. Bleeding: Some bleeding is expected, but excessive bleeding may require further intervention.

3. Infection: As with any surgical procedure, there is a risk of infection at the surgical site.

4. Recurrence: There is a possibility that fissures or hemorrhoids may recur after surgery, particularly if underlying issues such as constipation or straining during bowel movements are not addressed.

5. Fecal Incontinence: Although rare, damage to the anal sphincter can lead to issues with bowel control.

The likelihood of recurrence can depend on various factors, including adherence to postoperative care and lifestyle changes. It is crucial to follow your surgeon's advice regarding diet, bowel habits, and any prescribed medications to minimize the risk of recurrence.

As for postoperative care, it is generally advisable to have someone assist you during the initial recovery period. While many patients can manage their wound care and medication independently, having a family member or friend available can provide support, especially if you experience significant discomfort or have difficulty moving around. They can help with tasks such as changing dressings, preparing meals, and ensuring you stay hydrated.

In summary, while the thought of surgery can be anxiety-inducing, it can also provide significant relief from chronic pain and discomfort associated with anal fissures and hemorrhoids. Discussing your concerns with your surgeon can help clarify the procedure, recovery expectations, and any necessary lifestyle modifications to ensure the best possible outcome. Remember, effective communication with your healthcare provider is key to addressing your fears and ensuring a smooth recovery process.

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