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Suffering from anal fissure. Using shield topical ointment and lactulose to soften stools. Reoccurs on stopping medication. Suggest

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Hi Doctor, I am suffering from anal fissure that does not seem to go away. It subsides with care and medicine, but recurs. I am taking right now shield topical ointment, and lactulose to soften the stools. As long as I take the medicine, there's no pain and the inflammation is less, but if I stop or reduce the frequency I immediately have hardened stools and the problem recurs.
Posted Thu, 21 Nov 2013 in General Health
 
 
Answered by Dr. Lohit K 1 hour later
Brief Answer: Avoid hard stool,Lactulose,fluids & fibre diet. Detailed Answer: Hi XXXXXXX XXXXXXX thanks for using XXXXXXX I went through your query and understood your concern. Once the anal fissure has occurred then the next episode of minor trauma due to constipation or hard stool will lead the anal fissure to recur and if it continues the anal fissure tags will develop leading to difficult in healing. So adequate measures as explained below should be taken to completely heal the fissure and to prevent its damage later on. Anal fissures are usually caused by the bowel movement of a hard stool or repeated episodes constipation. When there is a fissure, the anal sphincter usually goes into spasm, thereby making bowel movements painful and more difficult, thereby delaying healing and sometimes, leading to worsening of the tear. Now, if your fissure is of a acute onset,then conservative measures should usually be sufficient to completely heal the fissure. You can try the following suggestions: 1. To prevent further hard stools: so eat fibre-rich foods, fruits, drinking plenty of water. 2. Continue use of laxative like lactulose for the next few days 3. For the pain and discomfort, use a topical anesthetic cream such as Lignocaine gel 4. Use Diltiazem or Nitroglycerine cream before passing stools, in order to relieve the spasm of the anal sphincter. Try Sitz baths: warm water bath that covers your hips and buttocks for two to three times a day for 20 minutes are often used to relieve pain, itching, or muscle spasms. This will relieve pain and speed healing. Key factor is to avoid hard stool, constipation and to keep the area dry. So follow the above measures for healing. In most cases, following these measures will heal the fissure and relieve symptoms within a few days or a maximum of 2 weeks. Hope this answered your query and is helpful for you. Feel free to ask if any related query and I will be glad to answer them. If you like my answers kindly rate it, and write a review as well. Wish you a very happy life and good health. Regards
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Follow-up: Suffering from anal fissure. Using shield topical ointment and lactulose to soften stools. Reoccurs on stopping medication. Suggest 24 hours later
Hello Doctor, Thank you for your advice. It seems that my fissure is of a more serious nature. It has been with me since more than 6 months now. I've been taking the due care. I've taken the medicine regularly for weeks at times, which reduces the symptoms, but it's not gone. This includes sitz baths too and a very strict diet. Please advise about the next course of action.
 
 
Answered by Dr. Lohit K 14 hours later
Brief Answer: Surgery, sphincterotomy Detailed Answer: Hi C XXXXXXX thanks for giving more information. If medical treatment does not solve your problem then you need to try for surgical management (sphincterotomy). Surgical management is done to relieve muscle spasm and hence aid in healing. So before going for surgery if you try regular use of high fibre diet, laxatives, plenty of fluids and Diltiazem or Nitroglycerine cream before defecation to relieve spasm for more than a couple of weeks even after disappearance of the symptoms, the medical management can help in healing and you can avoid surgery. If the wound does not heal then the option is surgery. Hope this answered your query. Wish you faster recovery and good health. Regards
Above answer was peer-reviewed by
 
Follow-up: Suffering from anal fissure. Using shield topical ointment and lactulose to soften stools. Reoccurs on stopping medication. Suggest 12 hours later
Thanks doctor, I will keep the medication going as I don't want to go for surgery.
 
 
Answered by Dr. Lohit K 5 hours later
Brief Answer: medical management is the best option Detailed Answer: Hi, Yes, medical management is the best option for now. Continue medicines and follow all the instructions. Wish you faster recovery and happy life. Kindly close the query if satisfied and write a review as well. Regards
Above answer was peer-reviewed by
 
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