Anal Wounds: Is It Fissure or Something Else? - Surgery

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Understanding anal wounds can be complex, especially when distinguishing between conditions like anal fissures and other potential issues. Based on your description, it seems you have been dealing with an anal wound for two months, and while you have been applying medication, the wound has not healed completely. You mentioned that there is bleeding on toilet paper and occasionally in your underwear, but you do not experience pain during bowel movements, which is somewhat atypical for an anal fissure.

Anal fissures are small tears in the lining of the anus, often caused by passing hard stools or straining during bowel movements. They typically present with sharp pain during and after bowel movements, and bleeding may occur, often bright red in color. However, the absence of consistent pain during bowel movements in your case raises the possibility that your condition might not be a classic anal fissure. It could be another type of anal wound or irritation, such as an anal ulcer or a skin tag, which can also cause bleeding without significant pain.

The fact that your doctor has not recommended surgery and has indicated that the wound may heal on its own is a positive sign. Many anal wounds can heal with conservative management, including dietary changes to ensure softer stools, increased hydration, and the use of topical treatments to promote healing and reduce inflammation. If the wound is not healing, it may be due to ongoing irritation or trauma, such as from bowel movements or inadequate hygiene.

As for your concerns about surgery, it is understandable to be apprehensive. Surgical interventions for anal fissures, such as lateral internal sphincterotomy, can be effective in providing relief and promoting healing, especially in chronic cases. However, they do carry risks, including potential complications like incontinence or changes in bowel habits. These risks are generally low, but they can be a source of anxiety for many patients.

If you choose not to undergo surgery, it is crucial to monitor your symptoms closely. If the wound does not improve or worsens, or if you start experiencing significant pain, changes in bowel habits, or other concerning symptoms, it would be wise to follow up with your healthcare provider. They may recommend further evaluation, such as a colonoscopy, to rule out other underlying conditions.

In summary, while your symptoms may suggest an anal fissure, the lack of consistent pain during bowel movements and the presence of bleeding could indicate a different issue. Conservative management is often effective, but if you have ongoing concerns or if the wound does not heal, further evaluation and discussion with your healthcare provider are essential. Remember, it is always better to address these concerns sooner rather than later to prevent complications and ensure proper healing.