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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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I have chronic anal fissure(s), my doctor first prescribed me

Answered by
Dr. Mahboob Ur Rahman

General & Family Physician

Practicing since :2012

Answered : 2302 Questions

Posted on Fri, 1 Mar 2019 in Lump
Question: I have chronic anal fissure(s), my doctor first prescribed me Scheriproct, when that (obviously) didn't work I was prescribed Rectogesic, after 2x 2 months of that didn't show results I was given more Scheriproct, both the cream and the suppository this time, still did not work. After this I was sent to hospital with the intention of being given Botox, after the initial checkup I was given a bed-spot to get a better sense of how vast the issue was. The surgeon proclaimed it wasn't bad and I would only need either fiber supplements or some syurup that'd soften my stool. After that didn't work I was again sent to the hospital, and this doctor prescribed both Rectogesic and Xylocain, in addition he said my sphincter was a bit tighter than it should've been, and so he wanted me to use a plastic tube he gave me to help dilate the sphincter. I unfortunately did not have the money to complete this treatment, my question is as follows: Should I try this treatment now that I have money or should I insist on having the injection, or potentially, is there another treatment I should ask about?
Answered by Dr. Mahboob Ur Rahman 1 hour later
Brief Answer:
Yes you can try it before the injection, or surgery

Detailed Answer:
Hi and Welcome to 'Ask a Doctor' service.
I have read your question and here is my advice.

Anal fissures main cause is constipation or increased anal tone. While treatment of acute fissures, that is of less than 6 weeks is only using stool softener and local creams. That's what you have already exhausted.

Once the fissure is chronic, and not helped by the above as in your case then there are few options available, all focusing to release the tightness of the anal sphincter. The choice to be made is between surgery, or botox injection, or dilatation.

Botox injection is a newer technic, it quite effective and safe and is now recommended to be offered before surgery. However, it's expensive and with time the may not be very effective. But still, it should be offered before surgery...

Surgery (lateral sphincterotomy) is the gold standard for cases not relieved by other methods. It's very effective as it partially cut the tight band around the anal canal and hence reduces the tone. But may cause incontinence hence is the last option. So This will be the other option with you, but let it be the last option.

Anal dilatation (like what you have been told) is not favoured a lot these days and look out of fashion. but still, it has a role if the problem is not too much. It's easy and simple and has less complication. It may be quite effective if done gradually. There is a role for it, many times it helps and may save the operation or the botox Inj.

So it may not be the method of choice, but if the problem is not very advanced, you may give it a try. So if you are teased by the problem a lot, or you are an ideal type of person, then off course botox injection is better options otherwise dilatation can be tried first. It all depends on personal choice.

Make sure not to stop using more fibres, stool softeners, more fluids to relieve constipation along with these methods. You may use the creams with it for the pain as well as the pain medicines if needed.

Hope this helps you.
Please feel free to ask if you have any further questions or concerns.
I will be glad to answer further.

Kind Regards
Dr Mahboob Ur Rahman

Above answer was peer-reviewed by : Dr. Arnab Banerjee

The User accepted the expert's answer

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