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Surgical removal of skin tags and anal fissures - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Digestion and Bowels
Answered by

General & Family Physician
Practicing since : 2009
Answered : 594 Questions

Doctor :   hi
User :   hi
Doctor :   how can i help you
User :   I wanted to ask if the doctors on this site can help with proctological issues
Doctor :   ya sure go on
User :   I have had a fissure and went to a specialist about it whom diagnosed me with a fissure, skin tag and an enlarged papillae
Doctor :   k
User :   he recommended a stool softner and drinking more water for 3 weeks
User :   I did so and the bleeding stopped, and I felt significantly better
Doctor :   did he advice you sitz bath ?
User :   no but I do try to take warm baths whenever possible (only once or twice a week though, too busy otherwise)
Doctor :   k
User :   I still see bleeding about once a month
Doctor :   now what is the problem?
User :   but not as bad as before
Doctor :   k
User :   so one concern is that
Doctor :   u need to continue with same medication
Doctor :   if it gets better well and good
Doctor :   or else it needs surgical correction
Doctor :   it depends on the degree

User :   ok, I just signed up
User :   still there?
Doctor :   ya
User :   when I was examined they couldn't even see the fissure, so I suspect it is minor enough that surgery may not be needed
Doctor :   are you back
User :   yes I just purchased the 7 day
Doctor :   k
Doctor :   give me 2 min i am going through your history
User :   no problem
Doctor :   k
Doctor :   do you have pain or does it pain when u touch the part?
User :   very little pain
User :   none right now
Doctor :   k
User :   pain is maybe 1 to 2 out of 10 on the pain scale and only when it bleeds about once per month
Doctor :   is there constipation?
User :   hard to say, I think I had minor constipation today, but did not have bleeding
User :   or pain
User :   I generally don't get severe constipation where I can't have a BM for several days
Doctor :   k
User :   so that is one of the issues
User :   there are several related
User :   that I would like to make you aware of
Doctor :   did the doctor tell you the degree of fossure?
Doctor :   ya sure go ahead
User :   the doctor initially examined me in Dec '08 he said he could not see the fissure, he also found a skin tag (sentinel pile) that was probably formed from the fissure (posterior) and an enlarged papillae on the opposite side
User :   but since he could not see the fissure I took this to be a good sign that it was minor, he only suggested ducosate sodium and more water
Doctor :   k
User :   he did not opt to use nitro glicerin or surgery
Doctor :   see since you have 4 months history
User :   docusate sodium and more water for one month stopped the bleeding and pain for me I had a follow up exam in January
Doctor :   i think it is still an acute condition
User :   that is good then!
User :   again he saw no fissure
User :   but I have had bleeding about once a month since then
Doctor :   it has to be get treated and follow my instructions
Doctor :   so that it is not complicated
User :   hold one sec
User :   I have a little more info
User :   to present that is important
User :   sorry
Doctor :   k
Doctor :   go ahead
Doctor :   are you there
User :   I asked another doctor if they had a recommendation for softening stool without docusate sodium (because docusate sodium can maybe create dependency or constipation on long term use), and he recommended lots of fruit and vegeatables and whole grains. So I added these to my diet but still had once a month issues, he then recommended no meat or dairy or eggs at all which I am doing now, only for two weeks so far so good, but I have concerns about this restrictive a diet in the long term
User :   And one other item that is of great concern
Doctor :   k
Doctor :   ya go ahead
User :   I feel a short pain of pressure between my tail bone and rectum when sitting in certain chairs in my office, it is mild 1-2 on pain scale but goes away immediately after I sit, only when I first sit. But about 2 weeks ago I had 4 BM's in one day and by the 3rd and 4th I felt a lump about the size of a grape underneath the skintag area and it hurt significantly during the BM. It has been returning during BM's since then but not nearly as painful (maybe the diet is helping temporarily), but it settles down and completely disappears after BM's (it is not a prolapsing hemmoroid because the lump is external), it is pale whitish in color when I view it in a mirror not red or purple. It returning during my BM today but was closer to pea sized than a grape (which I guess is good)
User :   ok I will let you take some time to read over all this and put it together
Doctor :   ya
Doctor :   i got it
User :   these problems have caused much anxiety for me, because I am struggling to find long lasting releif
Doctor :   so restriction of diet , bleeding and skin tag is a concern for you
Doctor :   sure we will help you
Doctor :   The thing is you have an acute condition of fissure
Doctor :   the skin tag which is present is an natures protection
Doctor :   to prevent the fissure further worsening
Doctor :   i will tell u in detail
User :   great
User :   thank you
Doctor :   fissure is nothing but a tear in the muscular area
User :   oh sorry also the lump is of concern to me
User :   please continue
Doctor :   so the end which is called a splincter develops a tag so that the tear doesn't extend further
Doctor :   once the tear is gone the tag will go off
Doctor :   and the bleeding occurs due to the passing of hard stools or during constipation
Doctor :   while passing stools the tear stretches causing the bleeding
Doctor :   got my point
Doctor :   so can u feel the lump ?
User :   yes, this part I understand, although the specialist that examined me said the skin tag would need to be removed in the office if I wanted it to be, he said it should not cause symptoms but doesn't usually go away on it's own
User :   but allowing the fissure to heal is the priority
User :   any suggestions you have to help this heal stronger is appreciated
Doctor :   ya
Doctor :   since it takes 2 to 3 weeks to heal if you follow my instructions
Doctor :   does any 1 in your family has same problems?
Doctor :   because congenital shortening of anus can cause it
User :   not that I know of
Doctor :   k it is just like an wound
Doctor :   if you can take care of it well it will heal
Doctor :   so here are few causes that cause the tear
Doctor :   pressure exerted while passing the stool
Doctor :   the hard stools
Doctor :   the food which u take
Doctor :   low fibre diet and spices
Doctor :   etc
Doctor :   weakened muscles
Doctor :   i like to ask you few questions to narrow down the cause
Doctor :   can you answer me?
User :   yes
Doctor :   before december where you eating spicy food?
Doctor :   or more of oily or meat foods?
User :   before december I think I was eating a lot of meat, some fibre but not a whole lot
User :   lots of carbs
User :   that wern't whole weat
User :   some spicy food
Doctor :   k
User :   but not everyday
Doctor :   do you smoke?
User :   no
User :   never smoked
Doctor :   you had constipation? or were you using laxatives a lot then?
User :   no use of laxatives, possibly mild constipation, BM's were about 1-2 times a day sometimes 1 every 2 days, but may have been hard stools (can't remember exactly)
Doctor :   in your case i consider food and constipation problems have caused the tear
Doctor :   but no need to worry or panic
Doctor :   it will probably heal if taken care of
User :   I think I also may have tried too forcefully when I wanted BM at convenient times
Doctor :   k
Doctor :   take plenty of water and fruit juices
Doctor :   this is to facilitate the easy bowel movements
Doctor :   and to avoid stools to pressurize on wounded area
Doctor :   avoid non veg and oily food for 3 weeks
Doctor :   later on u can continue using the normal diet
Doctor :   better u take it down or note it on a piece of paper
User :   I am taking notes now, good idea
Doctor :   3> use plenty of vegetables so that they contain high fibre
Doctor :   and help loosening the stools
User :   1.) Do you have any types of fruit juices that you particularly recommend, I've been drinking mostly orange juice in the morning and eating some mixed fruit 2. ) can you confirm what you mean by a normal diet?
Doctor :   4> maintain good hygiene .. cleaning in hot water and keeping the area wet
Doctor :   to avoid infection.. as wounded area is more prone to infections
Doctor :   ya orange, moosambi , pomogran, apple, water millon, carrot
User :   ok, got it
Doctor :   normal diet is once that gets healed u need not restrict your diet
Doctor :   5> pass stools 2 or 3 times daily rather than passing once
Doctor :   this will help you in small stools and less pressure on tear
Doctor :   6> use indian style toilets and spend time in toilet.. don't strain or force yourself to pass stools
Doctor :   to avoid further tear and give time to heal
User :   ok
Doctor :   when you feel to void just go for toilet
User :   will try
Doctor :   don't avoid or strain
Doctor :   7>avoid long distance travelling or walking
User :   is hot coffee (decaff) or tea a good stimulant to use?
User :   ok no travel planned in the next month or so but sometimes I have to travel on 15+ hr flights
Doctor :   avoid scratching non veg oily foods and spices for 3 weeks
Doctor :   ya hot coffee or tea will help you pass stools easily
Doctor :   coming to medications
Doctor :   use multivitamins- Tab Eldervit twice daily for 20 days
Doctor :   Vitamin E and Zinc tablet combination along with that
User :   ok, what does eldervit contain?
Doctor :   it contains almost all vitamins and minerals
Doctor :   and get seperate tabs for vitamin e and Zinc combination
User :   sounds like it's formulated for older persons, still good for someone my age? 25 yrs old
Doctor :   nothing like only for older person
Doctor :   since you have food restrictions
Doctor :   it is a better way to supplement
User :   ok
User :   understood
Doctor :   it will heal within 2 weeks
Doctor :   maximum 3 weeks
Doctor :   and also practice sitz bath
Doctor :   twice daily
Doctor :   put luke warm water in tub
User :   it has not bled for 2 weeks alreayd but I would like to allow for extended healing to allow it to strengthen really well to prevent reinjury
Doctor :   and sit for 10 min in it
User :   because it has been reinjuring about once a month
User :   minorly
Doctor :   to relieve spasm that is contractions or tightening
Doctor :   ya thats what let it heal completely this time
Doctor :   recurrence occurs so try to avoid it with these conservative treatment which i have told you
Doctor :   you can remove that tag surgically but chances of extension of tear are very great
Doctor :   so my advice don't go for it
Doctor :   once the tear is healed completely the tag will go off and reduce in size
Doctor :   you can notice it as the day progresses
Doctor :   all your doubts are cleared ?
User :   hmm, so best is to leave the tag for ever and it will shrink to nothing on it's own?
Doctor :   is there any thing else that i can assist you
Doctor :   ya u can see the decrease in size day by day
Doctor :   its a natures protection to prevent further extension of tear..
Doctor :   if u cut down that there are chances of extending the tear
User :   ok, I hope so but not so sure as the tag has been there for many months but this is the strongest treatment I have tried so maybe
User :   ok
Doctor :   Is there any thing else I can help you with? Please fill the feedback form say done when done.
User :   so that is issue 1, I have questions about the 2 related issues
User :   the minor pain of pressure when sitting and the lump
Doctor :   ya go ahead
Doctor :   pain is due to stretching of the tear
User :   but this pain is not burning or stinging it is pressure like pain
Doctor :   i will recommend you to apply the same ointment and sitz bath to relieve the pain
User :   still tear related?
Doctor :   due to bowel movements the stretching of wounded muscle will cause it
Doctor :   and about the lump
Doctor :   where is the lump u can feel?
Doctor :   size approx?
User :   ok pain does feel like muscle pain so maybe that makes sense
Doctor :   k
User :   ok the lump is located on the anal opening towards tail bone
User :   part of it is under the skin tag
User :   it was about grape size during BM
User :   today it was only pea sized during BM
Doctor :   k that lump is due to irritation or constant rubbing of the stools or due rubbing or it can be due to the healed tear with the scar
User :   not visable or fealable when no BM
Doctor :   for that i expect you to get a physical examination done and get the report
Doctor :   so that i can tell you the cause
Doctor :   whether it is due to muscle scar or something else
User :   ok, from symptoms does this sound like a hemmorhoid or a bruise?
User :   I will try and get an appointment with my GP over the next few weeks to examine it but it may be difficult because it is not visible when no BM
Doctor :   ya it can be due to internal bleed in the muscle
Doctor :   since it increases only on bm
Doctor :   it can be due to small internal bleeding
Doctor :   later on it decreases
Doctor :   after the blood goes off
Doctor :   got my point ?
User :   yes
Doctor :   k
Doctor :   any more questions?
User :   so this suggests that it is not a hemmroid?
User :   more of a muscle issue?
Doctor :   Is there any thing else I can help you with?
Doctor: that is called sentinile pile since it is at the edge
Doctor :   not exactly haemmorhoid
User :   I think the skin tag is a sentinel pile but this is a lump
Doctor :   did you sign up the feedback form?
User :   yes, I signed the first one but you can send a second one
Doctor :   it is well connected internally
Doctor :   so there will be small tracts.. in which small blood collects
User :   another doctor scared me that if I ever eat meat again this condition will return
Doctor :   no not like that if it is healed at a once then u need not have to restrict the diet
User :   ok
Doctor :   based on your symptoms i don't think it is major and reccur in your case
User :   this is good news - can I check back in in a few days? will this chat be saved in my record so that I don't have to re enter my history when I come back to HealthcareMagic?
Doctor :   ya it is stored in the chat
Doctor :   no need to give up the history again
User :   If I come back will I talk to the same doctor (you) or another?
Doctor :   u can come back any time
Doctor :   ya same doctor u can speak to
User :   how do I know it's same doctor it only shows Doctor for name?
Doctor :   Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.
Doctor :   since you are my patient i will only take up and speak to you
Doctor :   i know your problems better than other doctor na
User :   so I would need to visit only during certain hours to talk to you?
Doctor :   no it is 24/7 service
User :   but if it is same doctor how can it be 24/7, surely you are not availible 24/7?
Doctor :   iam available from night 10 to morning 8
User :   EST time?
Doctor :   which country you are from
User :   USA eastern standard time
Doctor :   No iam not aware of this time
User :   11PM in my time zone now
Doctor :   ok
Doctor :   1pm to 11pm
User :   ok thank you, I will let you go then
Doctor :   ok
Doctor :   BYe
User :   thank you for your time, I would like to touch base in a few days
User :   bye
Doctor :   Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.

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