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Suggest Treatment For Anal Fissure

Posted on Wed, 31 May 2017

Question: Fissures
Sir in apr 2016 i suffered 1 week with fissures. Later on after consulting doctor it was healed with in 10 days. Later on after 6 months i got and same was healed with suppository and diltiagel. But some times got mild pain which last with in 10 mins. Recently last month i got due to hard stool. It was almost healed. My doctor told it was negligible and suggested to use gel. Today i met ayurvedic doctor and he suggested manual diliation for 2weeks by givinganaesthetic injection. My query is that whether it is medical proven or good thing. And also read about botox injection in google. Requesting you to please suggest best option and also other options if any

Answered by Dr. Dr Manjunath Metri (39 minutes later)

Brief Answer:
Avoid constipation and half your problem solved.

Detailed Answer:
Hello Mr XXXX, welcome to HCM..
I read your question completely and have understood it well enough..

I thank you for posting your query here..
I being a surgeon, we encounter so many such cases..

I will analyze all your points and provide necessary explanation and how to go about..

1. Fissures one year back..
Healed after consulting doctor. Took 10 days to heal..
Yes, fissures are a real bad problem.
But let me tell you that, it's a very common problem nowadays.

2. Fissure again..
Yes, fissure is such disease that it keeps recurring over time..

3. Hard stools most common cause for such recurrent fissures..
And I suggest you to avoid constipation and it will heal your fissures..

4. Yes.. Manual dilatation is a very old well known procedure and many quacks do it for fissures.

Basically, the anal sphincter is in spasm and causes pain..
Surgically we do, Lateral internal sphinterotomy but, yes manual dilatation helps. But it's painful and troublesome and not advised nowadays.

5. Botox not helpful..
Various published papers deny effective use of Botox.

6. Best treatment according to me..
A. Avoid constipation.
Drink 4 to 5 litre water, avoid spicy foods, lot of fruits and vegetables, avoid or reduce coffee tea, non veg if consuming.

B. You can use local pain killers in the form of gel.

C. If you are not satisfied, please go ahead with surgery. It's safe and effective..

Hope I have answered all your questions..
In case you need further assistance, please let me know.
Will be happy to help.
Also, you can contact me directly on http://bit.ly/askdrmetri.
Take care..

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr Manjunath Metri (12 hours later)

Sir whether it will be cured if we follow A and B . Whether my anal canal will be relaxed if i follow. I dont know the issue of anal canal relaxation status.
Doctor told manual dilation will be helpful. Is it painful.
If fissures healed still requires dilation or surgery
Whether surgery will have side effects

Answered by Dr. Dr Manjunath Metri (7 minutes later)

Brief Answer:
Yes, conservative methods helps.

Detailed Answer:
Hello XXXX, welcome back...
Appreciate you for getting back with your doubts..

Please note these following things.

1. Yes, most of the case will be solved by conservative methods like A and B as I've told.
But if it's troublesome, then surgery is beneficial.
You are the best decision maker based on your symptoms.

2. Yes.. It can relax the sphincter with conservative means.

3. Manual dilatation is painful if you have acute fissures..

4. Fissures healed then no need for dilatation..

5. Surgery is safe. With minimal acceptable side effects..

Hope I have cleared your doubts.
In case you need any further assistance, please let me know.
Or, you can close the question and rate..

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Dr Manjunath Metri (2 days later)

Sir
if fissure is healed, whether i need to go for any medical process. is it required to go for muscle relaxation i.e to reduce resting pressure to avoid future fissures.

if yes, is there option other than botox,manual dilation,internal sphincterotomy

this is 3rd time i got. Generally it will be healed with in 10 to 15 days if i use gel.
i'm getting tension that it may recur in future.Im not able to concentrate on daily life.
Pls suggest best option

Answered by Dr. Dr Manjunath Metri (7 minutes later)

Brief Answer:
No, suggest not to think beyond

Detailed Answer:
Hi XXXX, welcome back..
I thank you for getting back with your doubts..
Happy to help you!

1. If fissure healed then, there is absolutely no need to go for any medical treatment.

2. No, if it's completely healed then there is no scope to think beyond assuming, you may develop fissures and hence need further intervention.

3. Answer is NO

4. Please use gel, give some time..
Do not worry too much..
And, please contact me in case you develop these problems again at http://bit.ly/askdrmetri

Will help you..

Hope I have answered all your questions.
Please feel free to ask, any other doubts if you have..
Or, kindly close the question and rate..
Take care..

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

Above answer was peer-reviewed by : Dr. Prasad