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Suggest Treatment For Painful Anal Fissures

Posted on Mon, 1 Aug 2016

Question: Sir/Ma'am,

I had a talk with Dr XXXXXXX on this forum regarding my anal fissure. According to him, sentinel tag formed due to fissure is not painful and is harmless but i feel pain on sentinel tag when applying diltiazem ointment (ointment suggested by Dr Rishi) on it. I can comfortably apply cream on entire anal opening but it only pains when it comes to back side of anus where sentinel tag is actually residing.
Please let me know is it normal during anal fissure or some other treatment is required?

Also, the pain has shifted its course from left side of anus to back side of anus in a week. Is this a matter for concern?

Thanks and regards
XXXX

Answered by Dr. Rishi (3 hours later)

Brief Answer:
It could be another fissure. Please get examined.

Detailed Answer:
Hi XXXXXXX
Good to hear from you.
Pain during applying cream is fairly normal due to the fissure. The pain should only be in the area of the fissure and no where else.
I hope you are not getting any episodes of constipation. It is extremely important to avoid constipation.
This pain around the back could be another fissure if constipation has persisted.
I suggest you stop using the cream for now and get yourself examined by a Surgeon. That would be the best thing to do. Then you could tell me what are his findings and I could guide you for the further course of action.
Take care and I hope you recover soon.
Dr Rishi, New XXXXXXX XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rishi (26 minutes later)

Sir,

There was no episode of constipation. I had nice and thorough bowel movement early morning with complete emptying of stomach. No full like feeling was there.
But Isabgol is not keeping my stools softer. I had hard stool, day before yesterday, it almost stuck at the opening and problem has worsen since then. I had to go to empty my stomach thrice today to satisfy and all the time the pain was unbearable, though it gets relieved with the application of Lignocaine ointment prescribed by you.

Also, I just had a look at my sentinel tag today in the mirror. It is mild pinkish in color with round shape at the back of anus.

I seriously want to do away with this problem without any surgical treatment. It's horrifying. Kindly help me.

I will also arrange for diagnosis by a surgeon and will keep you updated accordingly.

Thanks and regard
XXXX

Answered by Dr. Rishi (19 minutes later)

Brief Answer:
Change your laxative. Stop Isabgol.

Detailed Answer:
Hi,
Thanks so much for the reply.
If Isabgol is not keeping the constipation away then please try Syrup Lactulose 20ml at night or Tab Dulcolax at night to ease stool passage.
The sentinel tag looks something like what you describe.
But it would definitely be better to get yourself examined by a Surgeon to know what exactly it is.
Do not fear Surgical treatment as well. Please keep your mind open.
The surgical options are not as horrifying as the problem itself.
Please take care and keep in touch and do let me know what the Surgeon says.
Regards,

Dr Rishi.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Rishi (17 hours later)

Dear Sir,

Today I had a check up from Surgeon at Safdarjung Hospital, New XXXXXXX and have also uploaded the report and medicines prescribed by him which must have reached you.

Listening to my case, he directly said that it's an fissure-in-ano. I requested him to do a physical examination too which he did and found the result to be same. According to him, constipation only leads to such kind of problem and I need to prevent it from happening along with the change in diet i.e. more intake of fibres, fruits and water. Consequently, he has prescribed some medicines and treatment.

With all due respect sir, I apologetically would like to know whether I should continue with the treatment recommended by you or switch on to medicines & treatment of Safdarjung surgeon. Or I should add on some medicines from his list to your prescribed treatment.

Thanks and regards
XXXX

Answered by Dr. Rishi (2 hours later)

Brief Answer:
Continue same treatment presently.

Detailed Answer:
Hi.
Good to hear from you.
I did not know that you are in XXXXXXX If I knew you are in XXXXXXX then you could have shown to me only and I could have examined.
You should continue the same medicines that I had advised and if you can show me in the near future it would be good.
Do not worry, it would be fine.
You can contact me on 0000.
Take care,
Dr Rishi.

Above answer was peer-reviewed by : Dr. Priyanka G Raj

Follow up: Dr. Rishi (22 minutes later)

Sir,

Actually I am brother of XXXX. His company Ericsson Global Pvt Ltd has tie up with HCM. So, I always had to use his name to present my case to you. I am central govt. employee and come under Central Govt Health Scheme (CGHS), so I always had to refer to government hospital or empanelled hospitals only. This is the only reason that I couldn't visit you and had to refer myself to Safdarjung Hospital.

Your valuable suggestions has helped me a lot and there is certainly a relief today, though yesterday I was completely downtrodden by intensive pain and multiple BM sessions.

I always wanted myself to be physical examined by some surgeon and that was possible today just because of your sincere guidance.

I extend my heartiest gratitude to you sir. Will keep you updated.

Thanks n Regards XXXXXXX
b/o XXXX

Answered by Dr. Rishi (15 minutes later)

Brief Answer:
Good to know that you are feeling better.

Detailed Answer:
Hi XXXXXXX
Good to hear from you.
Good to know that you are feeling better.
Do feel free to contact me whenever you need.
Take care,
Dr Rishi.

Note: For further inquiries on surgery procedure and its risks or complications book an appointment now

Above answer was peer-reviewed by : Dr. Priyanka G Raj