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What is the cure for painful bowel movements while taking Preparation H and Hydrocortisone for itching in anus?

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General Surgeon
Practicing since : 1979
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I have pain when I move my bowels. The bigger/harder the stool the more it hurts. If I take a stool softener it doesn't hurt at all or hardly hurts. The pain is located towards the back and left side of my anus. Afterwards the pain is dull or it comes and goes. The next day it is gone until I move my bowels again. There is no noticeable blood in the toilet or on the paper. I will also have an itch in my anus after defecation which is usually helped by Preparation H, Hydrocortisone or Vaseline. Also, I've always had a problem getting my anus clean. If I wipe gently there is residue left behind way up in there and it will itch. But if I try to get it all clean by going way up in there I seem to irritate it. Finally, there is a small soft bump in the anal opening, but it hasn't changed and doesn't hurt. I'm a 51 male with no other symptoms. I had a colonoscopy about 6 years ago and it came out clean. I know I should go to the doctor, but I'm too freaked out. Please help.
Posted Sun, 19 Jan 2014 in General Health
Answered by Dr. M Y Shareef 3 hours later
Brief Answer: Though not a serious condition, should be taken ca Detailed Answer: Hi XXXX! Good morning. I am Dr Shareef, a general surgeon answering your query. From your history, it seems that you have got a fissure in Ano, which is a crack in the muco-cutaneous junction of the anal canal due to passage of hard stool and it happens in chronically constipated people. This is not a serious condition as your colonoscopy report is clean, but have to be taken care of both with medical and dietary measures and if not cured or troubled frequently , then a small surgery will relieve your symptoms. The small bump you mentioned could be a small skin tag, which occurs as a natural protective mechanism due to the fissure (sometimes known as external piles) If I were your doctor, I would advise you a regular sitz bath (sitting for 5 minutes on a tub of warm water) three times a day, an antibiotic which will be effective in both aerobic and anaerobic infection, an anti inflammatory drug after meals, a proton pump inhibitor drug, a non irritant laxative which should soften your stool, and a local ointment which contains lignocaine and diltiazem, which might relieve your symptoms. As the basic problem is chronic constipation, I would advise you to modify your dietary habits towards more of roughage like salads and fruits, and plenty of liquids with avoidance of fast food and non veg like mutton. You can go for fish which is more safe. If all these measures do not help you or there is frequent recurrence of the problem after being relieved, there is a simple surgery called lateral sphicterotomy, which releases the tight anal sphincter which holds back the stool in chronic condition. This helps in stool getting evacuated easily. But you have to adhere to your dietary modifications as advised. However you need a clinical examination by a doctor first before we confirm the diagnosis. So I would advise you to see your family physician/surgeon soon. I hope this information would help you in discussing with your family physician/treating doctor in further management of the problem. Please do not hesitate to ask in case of any further doubts. Thanks for choosing health care magic to clear doubts on your health problems. Wishing you an early recovery and also a Happy new Year 2014. Dr Shareef.
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