Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
199 Doctors are Online

Anal fissure , anal spasm and piles - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: General Health
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
Doctor :   hello
Doctor :  
how can i help u?
User :   Hello
User :   I have some issues of the GI, rectal, urinary system that I have some questions on
Doctor :  
hii
Doctor :   ok

Doctor :  
pls proceed
User :   ok let me just give you some basic history first
User :   I am young 26/M
User :   last 2-3 years my health has gone from okay to very poor
Doctor :  
ok
Doctor :  
ok
User :   about 3 years ago I seemed to become more sensative to what I ate, increased bowel movement frequency, foods like ice cream and pizza and even pasta with tomato sauce would cause urgent loose bowel movements
User :   then about 2 years ago, I started to develop abdominal pain
Doctor :  
ok
User :   and have had the abdominal pain on and off ever since
User :   at this time I also started experiencing increased urination
User :   form 3-4 times a day
User :   closer to 7-8 times
User :   I developed an anal fissure
User :   about 1 1/2 years ago
User :   which came and went
Doctor :  
ok
Doctor :  
ok
User :   then got bad so I went to the doctor who suggested a stool softener
User :   this helped a little but it came back
User :   so I saw another dr a few months ago
User :   but before I did I noticed my frequent bowel movements changed dramatically
Doctor :  
ok
User :   so for the past 6+ months it has been closer to constipation then high frequency
Doctor :  
ok
User :   foods that were passing through me quickly would still move quickly but then get stuck in the rectum
User :   at least that is how it has felt
Doctor :  
ok
User :   and then it is difficult to pass gas and lots of anal pressure especially when coughing or sitting or lifting
Doctor :  
ok
User :   so anyway this new dr. suggested nitroglycerin ointment
User :   for the fissure
Doctor :   ok

User :   which seemed to stop the bleeding
User :   almost 100%
User :   no more then pin sides spots of blood on the toilet paper
User :   but then I developed an external pile
User :   that got thrombosed
Doctor :  
ok
User :   so I insisted that it be removed
Doctor :  
ok
User :   and the dr agreed to do surgery
Doctor :  
ok
User :   which he did in office, it wasn't bad at all
Doctor :  
ok
User :   but in addition to the pile removal
User :   he did 2 botox injections into the internal sphincter muscle
Doctor :  
ok
User :   to reduce spasm and help the fissure to heal
Doctor :  
ok
User :   that was about 1 month ago
Doctor :  
ok
User :   I also started a new routine to ensure regular bowel movements
Doctor :  
ok
User :   drink coffee in the morning (use the coffee as a stimulant laxitive) and it seems to ensure exactly 1 bowel movement a day in the morning)
User :   so regularity is good
User :   but I still have this pressure
Doctor :  
ok
User :   if I eat some foods it causes abdominal pain and rectal pressure that doesn't go away until I have a bowel movement the next morning
Doctor :  
ok
User :   ok that is my summary, sorry it is so long
User :   my concerns are the pressure
User :   I want to avoid more piles, or anything worse that could happen requiring surgery
Doctor :  
its ok
User :   and it is uncomfortable as is
Doctor :  
whay are u being sorry u are most welcome
User :   thank you, I am sorry because in the US the Dr's don't have enough time to listen to this much history.
Doctor :  
according to the history u have given ur diagnosis is confirmed that u are having recurrent piles
User :   no, only had piles once I think
User :   and had it removed
Doctor :  
do u have painless bleeding even now?
User :   but I am worried that I could get more
User :   no more bleeding which is good
User :   but I do have some soreness and lots of itching
Doctor :  
have u taken ultrasound abdomen?
User :   I think the pile removal has healed quickly, but not sure about the fissure
User :   oh
User :   in terms of the abdomen I have had a sigmoidoscopy and also a bladder scan
User :   but not a full ultrasound
Doctor :   ok

Doctor :  
sometimes liver disease is associated with recurrent piles
Doctor :  
are u taking any hot sitz bath?
User :   you think this pressure is piles?
User :   last exam was clear other than a small external one
User :   ok, in terms of sits baths I did these for several months
User :   when I was using the nitroglycerin ointment
Doctor :   ok
User :   but I have stopped the ointment and baths because I no longer have as much free time to be treating this
Doctor :  
even piles have similar complaints like pressure in the rectum
User :   sometimes one bath / week
Doctor :  
what about the diet u are following?
User :   I have tried to add fibre, for breakfast I eat a bowl of cereal (with some fibre in it), lunch I have usually chicken or fish or a sandwich and some vegetables and rice or potatoes, sometimes salad or soup, for dinner maybe chicken, vegetables and rice or pasta.
User :   sometimes I eat fruit as well
User :   and fruit juice during the day
Doctor :  
Drink more liquids and eat more leafy green vegetables, which will make stools bulkier and softer to relieve constipation.

User :   I only drink soda or eat red meat occasionaly now
User :   but I have noticed this moves food quickly through my upper colon which is already fast
User :   but then it gets stuck in the rectum
Doctor :   no no
Doctor :  
dont take red meat and soda at any cost
User :   I don't anymore, very rarely
Doctor :  
u shuld be very catious ath this stage'
Doctor :   anal fissure is also associated with anal spasm which will lead to increased pressure in the recum
User :   I believe this increased pressure is the most likely problem
Doctor :  
ok
User :   this can cause stool to become trapped near the anus?
User :   and feeling as if the spincter ring wants to push out?
User :   difficulty passing gas?
Doctor :  
ok
User :   I had hoped the botox injection would relieve this pressure and I think it did but only by maybe 20% in terms of how it feels
Doctor :   ok ok
Doctor :  
or else we can put entire stuff like this
Doctor :  
anal sphincter spasm is the trigger
Doctor :  
which is the main reason for both anal fissure and hemorrhoids
Doctor :  
anal sphincter spasm is mostly due to lack of nitric oxide in the anal sphincter muscle which helps in relaxing the sphincter
User :   so the nitric oxide occurs naturally not just in the ointment?
Doctor :  
yes
Doctor :  
it is a natural gas component of the body which help in relaxing sphincters and also blood vessels
User :   I see
Doctor :  
in certain individuals there is lack of nitric oxide esp at anal sphincter
Doctor :  
which leads to recurrent piles and fissures
User :   even the pressure itself is uncomfortable
User :   I have 95% relief after bowel movements though
Doctor :  
yes
User :   but it comes back later in the day
Doctor :  
normally they give botulinum toxin to relieve this ,
User :   yes
User :   I got this 4 weeks ago
User :   2 shots
User :   but maybe not enough dose?
Doctor :  
inspite of that if it is not resolving then u can go for sphincterotomy
User :   this is major surgery though? cut in the muscle?
Doctor :  
but it has got its own disadvantage that it will make e ur sphincter incontinent
Doctor :  
i think u should go for higher dosage of botulinum toxin
User :   the surgeon I saw said this surgery is pretty severe and he does not recommend it
User :   do you know how much the doses usually are?
Doctor :  
normally it is around 150 units
User :   maybe I need a double dose?
Doctor :  
yes
User :   I have a surgery followup next week and will ask about getting more shots
User :   are you aware of patients that have to go for a second dose?
Doctor :  
but ur surgeon will guide u regarding dose management
User :   ok, I hope the injection is all I need because I don't think I can consider a cut in the muscle, even he recommended against it
Doctor :  
as he will be knowing what is the dose he has give previously and what is the dosage should be given now
Doctor :  
ok
User :   ok, also will the muscle be able to loose tone if it relaxes for 3 months?
User :   or will the problem come back after the shot wears off?
Doctor :  
there are evry chances of problem coming back
User :   ah, this is most stressful
Doctor :  
u should be in regular fne year which will give u the best resultsollow up of atleast o
Doctor :   for an year*

User :   am I at high risk for more severe conditions like rectal prolapse?
Doctor :  
yes
Doctor :  
but even after going for btx shots it will take a year to cure completely with regular follow up
Doctor :  
ur doctor may advice extra dose only if required
Doctor :  
if there is bo other go then he will suggest u laterla sphincterotomy
Doctor :  
form how many days ur ahaving this?
User :   the fissure or the pressure?
Doctor :  
t for u
User :   ?
Doctor :  
sorry last message not for u
User :   ok
Doctor :  
ok
User :   wow, this sounds very serious
User :   and that I may be in pain for a long time
User :   already been 2-3 years of struggle
User :   one last question
Doctor :   ok
User :   can my increased urination and post urination burning / dribbling be related?
User :   I saw a urologist that said all is normal
Doctor :  
sure
User :   but he could not examine my prostate due to post surgery
User :   ok, thank you very much for your time
Doctor :  
ok
Doctor :  
i will help u in this
Doctor :  
it may be becuiase of urinaary tract infection
Doctor :   are u there?
Doctor :  
are u there?
Question is related to
Diseases and Conditions
Medical Topics
© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor