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Suggest Treatment For Anal Fissures
Question: Hi
I have been suffering from anal fissures since 8 months. It started after taking prednisolone. I have and had IBS only. But one doctor I saw prescibed me prednisolone (60mg for first 10 days and then 40 mg for next 10 days and tapering off) for a total of 40 days. After 15 days of taking it, I started getting acne on my head, then my back and then chest and then I got anal fissure on 30th day. Then I stopped taking it. This prednisolone neither helped me in my IBS problem. This fissure was at 3 o clock. This fissure healed within 3-4 months, but two another fissure developed at 5 and 7 o clock. This new fissure used to be on and off. The 7 o clock fissure was rarely painful and that too only mildly. The 5 o clock fissure also gave pain only when stool was too bad, otherwise OK. But I wanted to get rid of this occasional irritation. So I went for a procedure a month ago (on 1st of April). The doc did mild dilatation (which is done without anesthesia using a dilator) and cut off a sentinel pile under local anesthesia using a thermal cautery device called Agnikarma method. First, the 4-5 injections he gave me in the anus for local anesthesia was very very painful and made me scream at every injection. Is that normal? I haven't read anyone's experience on net like that. Second, when my father saw the sentinel pile he cut, he saw that skin was also there attached to one end of sentinel pile. I think, he mistakenly plucked out the skin from beneath also. Is that normal? The anesthesia effect lasted barely for 30 mins. After 30 mins, I was feeling intense pain till night. After that, pain subsided a little. Then from next days, BMs became extremely painful. The pain became 10 times the pre-operation pain. I looked at my anus in the mirror by stretching a liitle. I saw deep big wound (at 7 o clock) where he might have cut the sentinel pile or plucked the skin from. There were another cuts at 3,4 o clock and a deep one at 10 o clock. May be he mishandled that device he used or something. My condition is now much much worse than before operation. Before operation, I used to feel mild pain occasionally, but now I am having intense pain everyday. I consulted with another surgeon. He prescribed me ciplox-oz for 10 days and zerodol s and told me to apply metrogyl p, lignocaine cream with nifidipine. He also told me to take 15 ml lactotil, 10ml cremaffin plus and 10 gms of isabgol (psyllium husk) everyday. When I took isabgol, my stool got worse next morning. It didn't come out easily causing me to strain more and hence worsened the fissures. The negative effect of isabgol remained for 2 days. So, I stopped taking isabgol and cremaffin too. Why did the isabgol not suit me though it is widely said to be an effective treatment for constipation. I started taking only 15 ml lactotil (66.67% w/v -lacsyp syrup from cipla). After 2-3 days, I started feeling some better, having less pain during BM. Then suddenly after 3 days of feeling better, again pain came back and became intense in further 2 days. Now I have been having the first part of stool as sticky and formed. Although formed stool is said to be good, but now the wound gets torn by it. And the stickiness of stool makes condition much worse. The stool, being sticky, doesn't pass out easily and requires more strain to push it down. This tears the wound and causes much pain. What can I do to avoid sticky stool. I am drinking atleast 3 litres of water per day and eating only grapes, pulses (yellow dal).
Yesterday night, I took one XXXXXXX (13.8 gms) of Movicol (polyethylene glycol 3350 and some other ingredients) with 500 ml of water and did not take lactotil. But today morning, the first part (first 20-30% of the stool) was sticky and formed and caused intense pain. Why hasn't the Movicol worked? Today, I decided to increase my dose of movicol to 2 sachets daily and took one XXXXXXX today with 200 ml of water after breakfast, the other one I am thinking to take at night. Please tell if movicol is right to take; will it improve the stools. Or should I take any other laxative? Will cremaffin plus be better? Can I take it for long term?
Can the wound heal if it re-tears again and again (assuming that when so intense pain occurs because of re-tearing of wound)? It's been a month since operation but the wound hasn't healed. Is it because the doc plucked out skin also along with sentinel pile. In how much time can I expect to heal?
If I dont heal, then what measures can I follow? Will CO2 laser treatment be good in which they evaporise the fissure, mount a thick layer over the fissure and the unhealthy tissues heal? Does that treatment make or enlarge the wound etc? Will sphincterotomy be good? Can these procedures heal this wound caused by cutting sentinel pile? Is there any hospital where CO2 laser treatment for anal fissures is done, especially in north India or Punjab? I have read that a procedure 'sacral nerve stimulation' is also used to treat fissures. Is it done in India anywhere? Does it heal?
Sometimes I also feel that my anal opening is tight. Is it that the dilation effect is weaning off? Is it OK?
A doc is offering me to do dilation using a dilator without any anesthesia. Is this possible. Wont this hurt? Can this worsen the wounds? Or can it be of use?
Is there any hospital where pneumatic balloon anal dilation is done? Is this good method?
Can I have prune juice to soften the stools? What should be the dose?
Can I continue taking zerodol s and for how long further?
Can I take cow ghee, milk , butter and jaggery. Will they help?
I have had IBS also for 7 years.
Sir, the question I am going to ask now can definitely make you think of me as stupid. But the intense pain like I am passing needles everyday for so much time has compelled me to think of this. I was just thinking of temporary colostomy until the fissures heal. Will the surgeon do it if I ask him for it or will he refuse?
After operation, I took photos of my wounds that were visible in the mirror by stretching gently. I will be uploading those also. Those are not visible from outside now, may be they have healed partially or the skin has tightened and seems to have gone inwards.
Should I take any medicine now? Any other creams?
I dont know if it is coincidence, but when I get sitz bath, pain starts. I have taken sitz bath just 4-5 times in a month because of this.
I also sometimes dont eat in good amount because of fear of stool.
Pls advise me, Sir.
Thanks
I have been suffering from anal fissures since 8 months. It started after taking prednisolone. I have and had IBS only. But one doctor I saw prescibed me prednisolone (60mg for first 10 days and then 40 mg for next 10 days and tapering off) for a total of 40 days. After 15 days of taking it, I started getting acne on my head, then my back and then chest and then I got anal fissure on 30th day. Then I stopped taking it. This prednisolone neither helped me in my IBS problem. This fissure was at 3 o clock. This fissure healed within 3-4 months, but two another fissure developed at 5 and 7 o clock. This new fissure used to be on and off. The 7 o clock fissure was rarely painful and that too only mildly. The 5 o clock fissure also gave pain only when stool was too bad, otherwise OK. But I wanted to get rid of this occasional irritation. So I went for a procedure a month ago (on 1st of April). The doc did mild dilatation (which is done without anesthesia using a dilator) and cut off a sentinel pile under local anesthesia using a thermal cautery device called Agnikarma method. First, the 4-5 injections he gave me in the anus for local anesthesia was very very painful and made me scream at every injection. Is that normal? I haven't read anyone's experience on net like that. Second, when my father saw the sentinel pile he cut, he saw that skin was also there attached to one end of sentinel pile. I think, he mistakenly plucked out the skin from beneath also. Is that normal? The anesthesia effect lasted barely for 30 mins. After 30 mins, I was feeling intense pain till night. After that, pain subsided a little. Then from next days, BMs became extremely painful. The pain became 10 times the pre-operation pain. I looked at my anus in the mirror by stretching a liitle. I saw deep big wound (at 7 o clock) where he might have cut the sentinel pile or plucked the skin from. There were another cuts at 3,4 o clock and a deep one at 10 o clock. May be he mishandled that device he used or something. My condition is now much much worse than before operation. Before operation, I used to feel mild pain occasionally, but now I am having intense pain everyday. I consulted with another surgeon. He prescribed me ciplox-oz for 10 days and zerodol s and told me to apply metrogyl p, lignocaine cream with nifidipine. He also told me to take 15 ml lactotil, 10ml cremaffin plus and 10 gms of isabgol (psyllium husk) everyday. When I took isabgol, my stool got worse next morning. It didn't come out easily causing me to strain more and hence worsened the fissures. The negative effect of isabgol remained for 2 days. So, I stopped taking isabgol and cremaffin too. Why did the isabgol not suit me though it is widely said to be an effective treatment for constipation. I started taking only 15 ml lactotil (66.67% w/v -lacsyp syrup from cipla). After 2-3 days, I started feeling some better, having less pain during BM. Then suddenly after 3 days of feeling better, again pain came back and became intense in further 2 days. Now I have been having the first part of stool as sticky and formed. Although formed stool is said to be good, but now the wound gets torn by it. And the stickiness of stool makes condition much worse. The stool, being sticky, doesn't pass out easily and requires more strain to push it down. This tears the wound and causes much pain. What can I do to avoid sticky stool. I am drinking atleast 3 litres of water per day and eating only grapes, pulses (yellow dal).
Yesterday night, I took one XXXXXXX (13.8 gms) of Movicol (polyethylene glycol 3350 and some other ingredients) with 500 ml of water and did not take lactotil. But today morning, the first part (first 20-30% of the stool) was sticky and formed and caused intense pain. Why hasn't the Movicol worked? Today, I decided to increase my dose of movicol to 2 sachets daily and took one XXXXXXX today with 200 ml of water after breakfast, the other one I am thinking to take at night. Please tell if movicol is right to take; will it improve the stools. Or should I take any other laxative? Will cremaffin plus be better? Can I take it for long term?
Can the wound heal if it re-tears again and again (assuming that when so intense pain occurs because of re-tearing of wound)? It's been a month since operation but the wound hasn't healed. Is it because the doc plucked out skin also along with sentinel pile. In how much time can I expect to heal?
If I dont heal, then what measures can I follow? Will CO2 laser treatment be good in which they evaporise the fissure, mount a thick layer over the fissure and the unhealthy tissues heal? Does that treatment make or enlarge the wound etc? Will sphincterotomy be good? Can these procedures heal this wound caused by cutting sentinel pile? Is there any hospital where CO2 laser treatment for anal fissures is done, especially in north India or Punjab? I have read that a procedure 'sacral nerve stimulation' is also used to treat fissures. Is it done in India anywhere? Does it heal?
Sometimes I also feel that my anal opening is tight. Is it that the dilation effect is weaning off? Is it OK?
A doc is offering me to do dilation using a dilator without any anesthesia. Is this possible. Wont this hurt? Can this worsen the wounds? Or can it be of use?
Is there any hospital where pneumatic balloon anal dilation is done? Is this good method?
Can I have prune juice to soften the stools? What should be the dose?
Can I continue taking zerodol s and for how long further?
Can I take cow ghee, milk , butter and jaggery. Will they help?
I have had IBS also for 7 years.
Sir, the question I am going to ask now can definitely make you think of me as stupid. But the intense pain like I am passing needles everyday for so much time has compelled me to think of this. I was just thinking of temporary colostomy until the fissures heal. Will the surgeon do it if I ask him for it or will he refuse?
After operation, I took photos of my wounds that were visible in the mirror by stretching gently. I will be uploading those also. Those are not visible from outside now, may be they have healed partially or the skin has tightened and seems to have gone inwards.
Should I take any medicine now? Any other creams?
I dont know if it is coincidence, but when I get sitz bath, pain starts. I have taken sitz bath just 4-5 times in a month because of this.
I also sometimes dont eat in good amount because of fear of stool.
Pls advise me, Sir.
Thanks
Brief Answer:
you need to take laxatives and sitz bath
Detailed Answer:
Hi Onkar,
Thanks for writing to HCM.
First thing, the procedure done by your doctor to cut the skin tags is correct. They are part of the skin only, so its obvious that it will also get cut. Thats normal.
And second, you dont need a laser or colostomy to heal such minor wounds, they would had healed in a week if you would had taken your medication correctly.
All laxatives work the same, all that is needed is titering their dose as per your stool consistency. You need to increase the dose of lactitol or cremaffin plus if you thing that the stools are still hard to cause pain, and if they get too loose, you need to decrease their dose. This needs to be titered by you only. This will prevent pain and tearing.
To heal the wounds, you need to take sitz bath. It does pains a bit in the start but there is nothing better than that in healing the wounds. Put a cap full of detol or savalon solution to it before sitting in it.
And yes, local anaesthetic do cause pain while they are being injected. Their action starts in two mins and lasts for half an hour only.
You can eat whatever you want. Also you can take zerodol as long as you have pain, but take it with food only else you will get gastritis.
You try to follow these for a week and see the response.
Hope i have been helpful.
Regards
Dr. Ashish Verma
you need to take laxatives and sitz bath
Detailed Answer:
Hi Onkar,
Thanks for writing to HCM.
First thing, the procedure done by your doctor to cut the skin tags is correct. They are part of the skin only, so its obvious that it will also get cut. Thats normal.
And second, you dont need a laser or colostomy to heal such minor wounds, they would had healed in a week if you would had taken your medication correctly.
All laxatives work the same, all that is needed is titering their dose as per your stool consistency. You need to increase the dose of lactitol or cremaffin plus if you thing that the stools are still hard to cause pain, and if they get too loose, you need to decrease their dose. This needs to be titered by you only. This will prevent pain and tearing.
To heal the wounds, you need to take sitz bath. It does pains a bit in the start but there is nothing better than that in healing the wounds. Put a cap full of detol or savalon solution to it before sitting in it.
And yes, local anaesthetic do cause pain while they are being injected. Their action starts in two mins and lasts for half an hour only.
You can eat whatever you want. Also you can take zerodol as long as you have pain, but take it with food only else you will get gastritis.
You try to follow these for a week and see the response.
Hope i have been helpful.
Regards
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Sir
Thank you for your reply. You mentioned that I would have healed in a week if I had followed medication properly, but I already took my meds properly (ciplox-oz and zerodol s for 10 days, metrogyl p ointment daily, nifidipine, xylocaine and laxative), but I haven't healed in even a month. That's why I am in worry that it has been so much time.
Why am I not healing?
Sir, the stool tears the wound on most of the days, can I heal this way or does the healing go back to zero when stool tears it?
I read that cremaffin plus has a stimulant laxative which sholud not be consumed for long. But I need to take laxative for long term to heal the wound. So, I didnt take it, but I want to ask you if it is safe for long use.
In the meantime, I have started taking polyethylene glycol 3350 (13 gms in morning and 19 gms at night) and it seems to soften the stools. Is it safe for long use? Can I increase its dose also if needed?
Should I repeat the course of ciplox oz or any other antibiotics?
Sometimes, when I insert my finger into my anus to apply cream, it hurts, may be it slides against the wound or fissure. Is it OK or does it worsen the wound and hinder the healing? How can I avoid this? I have my finger nails cut and short already.
I have been sitting on heating pad instead of sitz bath. Is this okay?
And sir, why did isabgol not suit me inspite of drinking so much water?
In how much time can I expect to heal? And most importantly, can I heal inspite of having hard stool (if I get hard stool despite taking laxative also) and get retorn?
Thanks, sir
Thank you for your reply. You mentioned that I would have healed in a week if I had followed medication properly, but I already took my meds properly (ciplox-oz and zerodol s for 10 days, metrogyl p ointment daily, nifidipine, xylocaine and laxative), but I haven't healed in even a month. That's why I am in worry that it has been so much time.
Why am I not healing?
Sir, the stool tears the wound on most of the days, can I heal this way or does the healing go back to zero when stool tears it?
I read that cremaffin plus has a stimulant laxative which sholud not be consumed for long. But I need to take laxative for long term to heal the wound. So, I didnt take it, but I want to ask you if it is safe for long use.
In the meantime, I have started taking polyethylene glycol 3350 (13 gms in morning and 19 gms at night) and it seems to soften the stools. Is it safe for long use? Can I increase its dose also if needed?
Should I repeat the course of ciplox oz or any other antibiotics?
Sometimes, when I insert my finger into my anus to apply cream, it hurts, may be it slides against the wound or fissure. Is it OK or does it worsen the wound and hinder the healing? How can I avoid this? I have my finger nails cut and short already.
I have been sitting on heating pad instead of sitz bath. Is this okay?
And sir, why did isabgol not suit me inspite of drinking so much water?
In how much time can I expect to heal? And most importantly, can I heal inspite of having hard stool (if I get hard stool despite taking laxative also) and get retorn?
Thanks, sir
Brief Answer:
i had ment for the laxatives
Detailed Answer:
Hi,
By saying that you would have healed earlier by taking medicines properly, i had ment the laxatives.
Unless your stools become soft enough to pass out without tearing, that wouldn't heal. Because whatever healing has taken place throughout the day get undone by its retearing.
As i had told previously, all laxatives work the same. You can take whichever you feel better, the goal is to have soft stools. You need to adjust the dose as per the response.
And that heating pad is not going to help. In sitz bath, the water with antiseptic solution added, goes inside the anal canal and helps in would disinfection, and the warm water increases the blood flow in the region and relaxes the anal sphincter. All these work in synergy to promote healing.
And its normal for the cream to hurt while application as the wound gets irritated. You can switch to a cream with also has a locally acting anaesthtic added to it in combination with diltexam, like one available in at the chemist by the trade name 'smuth'. It should releive your pain better. Apply it before and after defecation, and thrice a day.
Regards
Dr. Ashish Verma
i had ment for the laxatives
Detailed Answer:
Hi,
By saying that you would have healed earlier by taking medicines properly, i had ment the laxatives.
Unless your stools become soft enough to pass out without tearing, that wouldn't heal. Because whatever healing has taken place throughout the day get undone by its retearing.
As i had told previously, all laxatives work the same. You can take whichever you feel better, the goal is to have soft stools. You need to adjust the dose as per the response.
And that heating pad is not going to help. In sitz bath, the water with antiseptic solution added, goes inside the anal canal and helps in would disinfection, and the warm water increases the blood flow in the region and relaxes the anal sphincter. All these work in synergy to promote healing.
And its normal for the cream to hurt while application as the wound gets irritated. You can switch to a cream with also has a locally acting anaesthtic added to it in combination with diltexam, like one available in at the chemist by the trade name 'smuth'. It should releive your pain better. Apply it before and after defecation, and thrice a day.
Regards
Dr. Ashish Verma
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Sir
Thanks for your reply. I am trying to have my stools soft. But sir, my wound is in the condition sometimes soft stool (which can be said to be a little formed in the category of soft stools) causes me pain. In spite of taking laxatives, I sometimes get that kind of stool in starting which causes me pain. How can I avoid this, how can I have a soft and looser stool at the beginning itself?
Sometimes, I feel my anal opening tight while applying ointment. Yesterday night, I couldn't insert my finger to apply cream. Why is this tightness there?
And sir, when my finger irritates the fissure, does this also undo the healing?
Is there any special medicine to heal this wound.
Thanks
Thanks for your reply. I am trying to have my stools soft. But sir, my wound is in the condition sometimes soft stool (which can be said to be a little formed in the category of soft stools) causes me pain. In spite of taking laxatives, I sometimes get that kind of stool in starting which causes me pain. How can I avoid this, how can I have a soft and looser stool at the beginning itself?
Sometimes, I feel my anal opening tight while applying ointment. Yesterday night, I couldn't insert my finger to apply cream. Why is this tightness there?
And sir, when my finger irritates the fissure, does this also undo the healing?
Is there any special medicine to heal this wound.
Thanks
Brief Answer:
apply with an applicator
Detailed Answer:
Hi,
That smuth ointment that i had told you in the last reply has a long nozzled applicator that can be painlessly inserted in the opening and need to withdraw it while gently squeezing the tube. In this way the ointment will get applied all along the length of the anal canal thus giving better outcome.
The anal opening is tight due the pain which causes the anal sphincter to go into spasm.
All these issues can be managed with that ointment as it also has smooth muscle relaxant along with anesthetic in it.
Give it a try.
Regards
Dr. Ashish Verma
apply with an applicator
Detailed Answer:
Hi,
That smuth ointment that i had told you in the last reply has a long nozzled applicator that can be painlessly inserted in the opening and need to withdraw it while gently squeezing the tube. In this way the ointment will get applied all along the length of the anal canal thus giving better outcome.
The anal opening is tight due the pain which causes the anal sphincter to go into spasm.
All these issues can be managed with that ointment as it also has smooth muscle relaxant along with anesthetic in it.
Give it a try.
Regards
Dr. Ashish Verma
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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