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Suggest Treatment For Anal Fissures
Question: Sir/Maam, Is there any hospital in India where carbondioxide laser treatment of anal fissures is done in which fissures are evaporated using laser. If there are many hospitals, pls give the list and especially in north india. I live in Punjab.
Pls tell the details of this method. What are the outcomes of this method, its success rate, cost and possible complications?
I have been suffering from anal fissures. I underwent an operation a month ago. The doc did mild dilation and cut off sentinel pile using a thermal cautery device. But the operation was not a success. He mishandled that device and left me with multiple big wounds which are causing me severe pain (much more than before) while passing even soft stools.
I am applying nifidipine, metrogyl p, xylocaine and taking lactotil 66.67%(lacsyp from cipla) 15 ml in night. Is lactotil and its dose right or should i prefer lactulose? i have been suffering from ibs for 7 yrs. Is ibs any connection with taking lactotil? How long can i safely take this? can i take cremaffin plus also and how long? is cremaffin or cremaffin plus better?
im not even eating well because of the fear of stool.
The wound left after cutting sentinel pile causes much pain. Can this wound be said to be an anal fissure? Will the ointments used to treat anal fissures treat this wound also? Will laser treatment heal this wound? And will LIS heal this wound? Or can this wound not be treated by these surgeries?
if i dont undergo any surgery, in how much time can i expect to heal?
I have taken ciplox-oz and zerodol s for 10 days. Now taking zerodol s.
Now i am feeling that my anal opening is getting tight. Is it that the dilation effect is wearing off?
Is further dilation of use?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?
I request you to answer the whole question as I dont have much money, Sir.
Pls tell,sir.
Pls tell the details of this method. What are the outcomes of this method, its success rate, cost and possible complications?
I have been suffering from anal fissures. I underwent an operation a month ago. The doc did mild dilation and cut off sentinel pile using a thermal cautery device. But the operation was not a success. He mishandled that device and left me with multiple big wounds which are causing me severe pain (much more than before) while passing even soft stools.
I am applying nifidipine, metrogyl p, xylocaine and taking lactotil 66.67%(lacsyp from cipla) 15 ml in night. Is lactotil and its dose right or should i prefer lactulose? i have been suffering from ibs for 7 yrs. Is ibs any connection with taking lactotil? How long can i safely take this? can i take cremaffin plus also and how long? is cremaffin or cremaffin plus better?
im not even eating well because of the fear of stool.
The wound left after cutting sentinel pile causes much pain. Can this wound be said to be an anal fissure? Will the ointments used to treat anal fissures treat this wound also? Will laser treatment heal this wound? And will LIS heal this wound? Or can this wound not be treated by these surgeries?
if i dont undergo any surgery, in how much time can i expect to heal?
I have taken ciplox-oz and zerodol s for 10 days. Now taking zerodol s.
Now i am feeling that my anal opening is getting tight. Is it that the dilation effect is wearing off?
Is further dilation of use?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?
I request you to answer the whole question as I dont have much money, Sir.
Pls tell,sir.
Brief Answer:
Medical management and further investigations
Detailed Answer:
HI.
Thanks for such an elucidate information and proper questioning and understanding you have got about anal fissures.
First of all, remember that one of the most important reason for getting a fissure-on-ano is IBS itself and both these problems have a psychological factor as a causative/ enhancing factor. I understand this may be an odd thing for you , but understanding this angle is very important for you. Unless this factor is negated the healing is not possible. The Practical and theoretical knowledge says there is a 35 percentage chance of recurrence and unfortunately you case is one of them.
Let me try to answer all your questions in the best possible way I can try.
CO2 laser treatment has no special role in the treatment of anal fissure. Laser is just one to to cut the tissues in a precise way, as someone used scalpel blade in the usual way. In Punjab you can get the list easily by net-search. And I am of the opinion that now you should not have any further woulds; let us try to heal the present ones first.
There is added advantage and this is not cost-effective method, Evaporating fissures by CO2 Laser is going to cause further enlargement of the wound.
Thanks for telling me what the Surgeon has exactly done. Now the pain is caused by the open wounds, which have more nerve endings exposed. This is why you are getting severe pain than before even on passing soft stools. You can apply the Xylocaine jelly before passing the motion to reduce this pain.
You are on the right medications and you need not take more or other laxatives if you are passing soft stools. Lactitol is fine in the dose you are taking and you have to adjust the dose as per your requirements.This is better than Cremaffin /plus and may not suit you as you have IBS.
You have to take absolutely normal diet whichever suits you. There is nothing to be afraid of. Yes, you should not take something which you already must have noticed to cause more problems for IBS.
The new wound more than a line is a wound and not a fissure. Yes the ointments for both conditions are going to be the same. Now the Laser will enlarge the existing wound more and will not heal this more.
At the moment you do not need any surgery at all. In fact you should refrain from further surgeries. The healing and duration will depend on many factors which I will give in the last paragraph.
The dilatation effect is to relax the internal sphincter alone. The healing effect will give you the feeling of tightening.
It is a good idea to use manual dilatation without general anesthesia is a good option. Giving general anesthesia every-time has its own risks and not needed if the dilators are passed after local/ topical application of xylocaine jelly in a graduated mode. ( we have numbered dilators- meaning start passing the thinnest and gradually to increase the size as per tolerance of the patient). This wont hurt. We do this regularly. This will not worsen the wounds. This is helpful.
Pneumatic balloons have no added advantage. It is better to follow the established way of treatment.
Go for :
Sitz bath regularly.
Control of IBS is a must for the anal fissures and wounds to heal.
Over-thinking and getting stressed causes delayed healing.
A good sound sleep, Meditation helps for both your conditions.
Avoid doing any activity which causes more mental and physical stress and strain.
I hope you have been investigated by Colonoscopy and CT scan abdomen and other tests to rule out tuberculosis or such general diseases,.
Wishing you an early recovery.
Feel free to ask more if you want any further clarification.
Medical management and further investigations
Detailed Answer:
HI.
Thanks for such an elucidate information and proper questioning and understanding you have got about anal fissures.
First of all, remember that one of the most important reason for getting a fissure-on-ano is IBS itself and both these problems have a psychological factor as a causative/ enhancing factor. I understand this may be an odd thing for you , but understanding this angle is very important for you. Unless this factor is negated the healing is not possible. The Practical and theoretical knowledge says there is a 35 percentage chance of recurrence and unfortunately you case is one of them.
Let me try to answer all your questions in the best possible way I can try.
CO2 laser treatment has no special role in the treatment of anal fissure. Laser is just one to to cut the tissues in a precise way, as someone used scalpel blade in the usual way. In Punjab you can get the list easily by net-search. And I am of the opinion that now you should not have any further woulds; let us try to heal the present ones first.
There is added advantage and this is not cost-effective method, Evaporating fissures by CO2 Laser is going to cause further enlargement of the wound.
Thanks for telling me what the Surgeon has exactly done. Now the pain is caused by the open wounds, which have more nerve endings exposed. This is why you are getting severe pain than before even on passing soft stools. You can apply the Xylocaine jelly before passing the motion to reduce this pain.
You are on the right medications and you need not take more or other laxatives if you are passing soft stools. Lactitol is fine in the dose you are taking and you have to adjust the dose as per your requirements.This is better than Cremaffin /plus and may not suit you as you have IBS.
You have to take absolutely normal diet whichever suits you. There is nothing to be afraid of. Yes, you should not take something which you already must have noticed to cause more problems for IBS.
The new wound more than a line is a wound and not a fissure. Yes the ointments for both conditions are going to be the same. Now the Laser will enlarge the existing wound more and will not heal this more.
At the moment you do not need any surgery at all. In fact you should refrain from further surgeries. The healing and duration will depend on many factors which I will give in the last paragraph.
The dilatation effect is to relax the internal sphincter alone. The healing effect will give you the feeling of tightening.
It is a good idea to use manual dilatation without general anesthesia is a good option. Giving general anesthesia every-time has its own risks and not needed if the dilators are passed after local/ topical application of xylocaine jelly in a graduated mode. ( we have numbered dilators- meaning start passing the thinnest and gradually to increase the size as per tolerance of the patient). This wont hurt. We do this regularly. This will not worsen the wounds. This is helpful.
Pneumatic balloons have no added advantage. It is better to follow the established way of treatment.
Go for :
Sitz bath regularly.
Control of IBS is a must for the anal fissures and wounds to heal.
Over-thinking and getting stressed causes delayed healing.
A good sound sleep, Meditation helps for both your conditions.
Avoid doing any activity which causes more mental and physical stress and strain.
I hope you have been investigated by Colonoscopy and CT scan abdomen and other tests to rule out tuberculosis or such general diseases,.
Wishing you an early recovery.
Feel free to ask more if you want any further clarification.
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Sir
Thanks for your reply. I want to ask what is the benefit of cutting sentinel pile if the wound created through this process is bigger than earlier fissure. If small fissure is taking so much time to heal, then it seems this wound will take years to heal.
And one night, I took 3-4 tsps of sat isabgol (approx 9 gms) with 1.25 liters of water. I also took 2 tsps (10 ml) of cremaffin plus. But it worsened my condition next morning. The stool wouldn't come out easily and I had to strain causing my fissures to worsen. This effect remained for 2 days and on the 2nd day, the stool was even more worse.
Three-four months ago also, same happened.
Why does isabgol not suit me whereas it is said to be an effective way to soften the stools?
Can I have prune juice to soften the stools? What should be the dose? Are there any side effects? Will it soften the stools more in addition to what lactotil is doing?
The stools are already soft, but the wound pains everyday.
How long can I safely use lactotil?
Actually, my fissure problem started having having prednisolone. I have and had IBS only not IBD, but a doctor prescribed me prednisolone (60 mg for first 10 days, then 40 mg, 20 mg, 10 mg) for a total of 40 days. After a month of taking it, I developed fissure even I had not any problem of constipation then. Can there be any effect of prednisolone now? Can there be any factor which is hindering my healing?
I had ultrasound of abdomen which was normal.
Can sphincterotomy be helpful or not?
I tried to search hospitals for CO2 laser treatment but could not find. Can you suggest me some? I just want to talk to them. I read that they laser shut the fissure (no cutting of sphincter). Is that the same?
My stool is soft everyday but the slightest pressure of its coming down causes pain. Can I do something to resolve it or to soften the stools more?
In CO2 laser treatment , I read that a thick layer of healthy tissue or something is mounted over the fissure and the unhealthy tissue heals gradually. But do they make or enlarge the wound?
Should I take ciplox-oz again for some days? And I am taking zerodol s. Should I continue it? Can it cause constipation or lactotil will overcome this?
You said that pneumatic balloons have no extra advantage, but pls tell whether it is performed anywhere for anal fissures.
In how much time can I expect to heal completely? Acually before the operation, I was very well (almost 90% ok). I used to feel pain after 4-5 days and that too if stool is too bad. I went for the operation to get to 100%, but it left me with all the negativity.
And are there any diet recommendations?
I take grapes, soup, dal.
Thanks
Onkar
Thanks for your reply. I want to ask what is the benefit of cutting sentinel pile if the wound created through this process is bigger than earlier fissure. If small fissure is taking so much time to heal, then it seems this wound will take years to heal.
And one night, I took 3-4 tsps of sat isabgol (approx 9 gms) with 1.25 liters of water. I also took 2 tsps (10 ml) of cremaffin plus. But it worsened my condition next morning. The stool wouldn't come out easily and I had to strain causing my fissures to worsen. This effect remained for 2 days and on the 2nd day, the stool was even more worse.
Three-four months ago also, same happened.
Why does isabgol not suit me whereas it is said to be an effective way to soften the stools?
Can I have prune juice to soften the stools? What should be the dose? Are there any side effects? Will it soften the stools more in addition to what lactotil is doing?
The stools are already soft, but the wound pains everyday.
How long can I safely use lactotil?
Actually, my fissure problem started having having prednisolone. I have and had IBS only not IBD, but a doctor prescribed me prednisolone (60 mg for first 10 days, then 40 mg, 20 mg, 10 mg) for a total of 40 days. After a month of taking it, I developed fissure even I had not any problem of constipation then. Can there be any effect of prednisolone now? Can there be any factor which is hindering my healing?
I had ultrasound of abdomen which was normal.
Can sphincterotomy be helpful or not?
I tried to search hospitals for CO2 laser treatment but could not find. Can you suggest me some? I just want to talk to them. I read that they laser shut the fissure (no cutting of sphincter). Is that the same?
My stool is soft everyday but the slightest pressure of its coming down causes pain. Can I do something to resolve it or to soften the stools more?
In CO2 laser treatment , I read that a thick layer of healthy tissue or something is mounted over the fissure and the unhealthy tissue heals gradually. But do they make or enlarge the wound?
Should I take ciplox-oz again for some days? And I am taking zerodol s. Should I continue it? Can it cause constipation or lactotil will overcome this?
You said that pneumatic balloons have no extra advantage, but pls tell whether it is performed anywhere for anal fissures.
In how much time can I expect to heal completely? Acually before the operation, I was very well (almost 90% ok). I used to feel pain after 4-5 days and that too if stool is too bad. I went for the operation to get to 100%, but it left me with all the negativity.
And are there any diet recommendations?
I take grapes, soup, dal.
Thanks
Onkar
Brief Answer:
Follow the SUrgeon
Detailed Answer:
HI Onkar.
Nice to know your very good research...
Do yo think that Knowing all these details are really going to help you or mar the progress. I have sternly written in the first place that all those patients who have this tendency to dig out more and not fully believing in the Doctor have more problems even for the IBS and conditions like fissures and other Psychosomatic disorders.
Please do not take otherwise, knowledge is meant to be sought but there is a limit and I frankly think that your over-research is going to create more problems than the actual healing is going to take.
I will try to answer again in a chronology ::
#(I want to ask what is the benefit of cutting sentinel pile if the wound created through this process is bigger than earlier fissure. If small fissure is taking so much time to heal, then it seems this wound will take years to heal.)
>> You only have a sentiment that this will now take years to heal. The benefit is cutting sentinel pile: The source of infection under the root of sentinel pile is removed by de-roofing this. Whether the would is small or large the healing time is always the same provided other negative factors are not there.
# (And one night, I took 3-4 tsps of sat isabgol............ Why does isabgol not suit me whereas it is said to be an effective way to soften the stools?...safely use lactotil? )
>> Isabgol is not well researched product in Allopathy and its effects can not be anticipated. And it looks you just wanted to experiment.. Please abide by the medical advise and do not try something on your own. See you already had a problem with it. You can continue Lactotil till you are symptoms free and till the healing is complete. This is safe and you can always adjust the dosage as per your requirements of softening the stool. Why do you want to try prune juice or any other products at all?
# (Actually, my fissure problem started .........an sphincterotomy be helpful or not?)
>>> Starting the steroids would have started to fissure at an early stage and not after one month. Onkar, I not here to prove or disprove; I am trying to correlate your history and findings. There can not effects of prednisolone now if you are not taking it. The IBS itself looks to be an hindering factor added on by your over-anxiety. This has a direct bearing on the outcome of any healing process.
#Sphincterotomy.
>> All the cases of dilatation already have this sort of effect of spincterotomy. IN this case by dilatation or by actually cutting it. It is needed only if the Surgeon feels it necessary on DIGITAL manual examination that the sphincter is tight. Otherwise can have further complications.
OK, I am still searching but could not locate any center with CO2 Laser trying on anal fissures.. I will let you know the moment I have the slightest of the hint, I assure you and will share any knowledge about it the moment I get it. Also not much idea about Pneumatic balloons as the traditional way of treating fissures is an established method. Any procedure is going to increase your wound area at the moment.
Antibiotics to be taken only if there is a an active infection as decided by your treating Surgeon. Do not take Ciplox OZ now.
At the most you can always go for another ( second as we say) opinion of another Surgeon.
If you do not disturb the healing process, the healing should occur within three weeks.
To Repeat- you can have all the foods , which you have experienced cause no problems to you in personal effect. Do not listen to others, they just confuse you.
Now Do this::
Stop self medication , dose alteration and thinking about your problems and searches. Believe in your Surgeon or take a second opinion
Follow what HE says ..
Follow the SUrgeon
Detailed Answer:
HI Onkar.
Nice to know your very good research...
Do yo think that Knowing all these details are really going to help you or mar the progress. I have sternly written in the first place that all those patients who have this tendency to dig out more and not fully believing in the Doctor have more problems even for the IBS and conditions like fissures and other Psychosomatic disorders.
Please do not take otherwise, knowledge is meant to be sought but there is a limit and I frankly think that your over-research is going to create more problems than the actual healing is going to take.
I will try to answer again in a chronology ::
#(I want to ask what is the benefit of cutting sentinel pile if the wound created through this process is bigger than earlier fissure. If small fissure is taking so much time to heal, then it seems this wound will take years to heal.)
>> You only have a sentiment that this will now take years to heal. The benefit is cutting sentinel pile: The source of infection under the root of sentinel pile is removed by de-roofing this. Whether the would is small or large the healing time is always the same provided other negative factors are not there.
# (And one night, I took 3-4 tsps of sat isabgol............ Why does isabgol not suit me whereas it is said to be an effective way to soften the stools?...safely use lactotil? )
>> Isabgol is not well researched product in Allopathy and its effects can not be anticipated. And it looks you just wanted to experiment.. Please abide by the medical advise and do not try something on your own. See you already had a problem with it. You can continue Lactotil till you are symptoms free and till the healing is complete. This is safe and you can always adjust the dosage as per your requirements of softening the stool. Why do you want to try prune juice or any other products at all?
# (Actually, my fissure problem started .........an sphincterotomy be helpful or not?)
>>> Starting the steroids would have started to fissure at an early stage and not after one month. Onkar, I not here to prove or disprove; I am trying to correlate your history and findings. There can not effects of prednisolone now if you are not taking it. The IBS itself looks to be an hindering factor added on by your over-anxiety. This has a direct bearing on the outcome of any healing process.
#Sphincterotomy.
>> All the cases of dilatation already have this sort of effect of spincterotomy. IN this case by dilatation or by actually cutting it. It is needed only if the Surgeon feels it necessary on DIGITAL manual examination that the sphincter is tight. Otherwise can have further complications.
OK, I am still searching but could not locate any center with CO2 Laser trying on anal fissures.. I will let you know the moment I have the slightest of the hint, I assure you and will share any knowledge about it the moment I get it. Also not much idea about Pneumatic balloons as the traditional way of treating fissures is an established method. Any procedure is going to increase your wound area at the moment.
Antibiotics to be taken only if there is a an active infection as decided by your treating Surgeon. Do not take Ciplox OZ now.
At the most you can always go for another ( second as we say) opinion of another Surgeon.
If you do not disturb the healing process, the healing should occur within three weeks.
To Repeat- you can have all the foods , which you have experienced cause no problems to you in personal effect. Do not listen to others, they just confuse you.
Now Do this::
Stop self medication , dose alteration and thinking about your problems and searches. Believe in your Surgeon or take a second opinion
Follow what HE says ..
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear Sir
Thank you very much for your reply and valuable advice. You mentioned that the wound should heal within 3 weeks if healing process is not disturbed. Please tell what the 'disturbing' means here. Is it meant by having hard stools? I am having soft stools. But they cause pain, so even these soft ones are harder for me which were not before the operation. So do these disturb the healing process? What are the factors that can hinder the healing process?
I am applying lignocaine jelly also before BM.
Day before yesterday, I went for BM two times a day and felt less pain than some days before. But yesterday again the pain was more even the stools were soft. Same happened some days ago also. I felt good for 3 days and next day, the pain increased significantly even though I didn't change my diet, took lactotil and stools were also soft. Why does this happen? If this happens, does it mean that wound retears and healing process is disturbed? Does it mean that the progress I achieved reversed when this retear happened? I am not understanding why this happens while I do not make changes in anything.
And today, the stool was formed and a little hard in the beginning. It was sticky also and didn't pass out easily and caused much pain. Did this also disturb the healing? I am eating nothing bad. I am eating less and that only grapes, soup and dal and drinking atleast 3 litres of water per day.
Why is stool sticky although I am having so much water? What can I do to avoid this?
I have had this operation on 1st of April. It's been a month, but I am still in pain. I worry why it has not healed within 3 weeks. How much more time will it take? Some skin was also plucked out from the anus while cutting the sentinel pile out. Had it made the wound deeper and difficult to heal?
One thing I want to tell you that after the operation, I could see my wounds in the mirror by stretching my anus gently. But after 15 days, they were not so visible. Now I cannot see at all either because they are not outside now or because of tightening of anus. The skin there seems to shrink inwards and the ring is also not clearly visible as it was after the operation. Is it a matter to worry about? I think anus has come to its pre-op size.
You said that any surgery now will only increase the wound. Will the dilator without anesthesia also do the same? Should I go for it? Will it help heal the wound or can worsen it also? What might be the cause of my getting so many wounds after operation-misperformed dilation or that thermal cautery device?
And I didn't take isabgol in self-medication. The surgeon I consulted after the surgery told me to take this and all other medicines I took. But when I told him about my condition getting worse after taking this, he asked me to continue which I couldn't. He told me that this would help in the long run. That's why I asked you about that.
Should I continue taking zerodol s and for how long further?
On some days when I feel intense pain during BM, I eat very less because of fear of stool. I mostly take fluids. Won't lactotil harm in that case (if we eat less)?
I am currently applying nifidipine (0.3%) with 1.5% lignocaine and metrogyl p. Are there any other ointments that can work faster or better? Can the tightness of anus be caused by metrogyl p?
Sir, since the motions are sticky, should I take polyethylene glycol based laxative like Movicol. Can you recommend a brand? What should be its dose? How to take it?
I asked about prune juice because I thought it might help me get softer stools.
Can I take cow ghee, milk , butter and jaggery. Will they help?
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?
And sir, can flight travelling affect the fissure?
I had test of ESR and ultrasound of abdomen. They were normal. Should I undergo another tests? I had colonoscopy in 2011 and it was normal. I had non-specific ulcers. They doctors said they were normal.
Since my subscription is soon going to end, I will have to take another one if I want to have further consultation, then in new thread, how can I connect to you? Conversation with another doctor will require me to tell the things from the scratch again whereas you know the whole situation of mine now.
After operation, I took photos of my wounds that were visible in the mirror by stretching gently, would you have a look at them? How can I send those to you?
Sir, can I reach a condition when I can eat everything while not taking any laxative and still not have pain?
Thanks a lot,
Onkar
Thank you very much for your reply and valuable advice. You mentioned that the wound should heal within 3 weeks if healing process is not disturbed. Please tell what the 'disturbing' means here. Is it meant by having hard stools? I am having soft stools. But they cause pain, so even these soft ones are harder for me which were not before the operation. So do these disturb the healing process? What are the factors that can hinder the healing process?
I am applying lignocaine jelly also before BM.
Day before yesterday, I went for BM two times a day and felt less pain than some days before. But yesterday again the pain was more even the stools were soft. Same happened some days ago also. I felt good for 3 days and next day, the pain increased significantly even though I didn't change my diet, took lactotil and stools were also soft. Why does this happen? If this happens, does it mean that wound retears and healing process is disturbed? Does it mean that the progress I achieved reversed when this retear happened? I am not understanding why this happens while I do not make changes in anything.
And today, the stool was formed and a little hard in the beginning. It was sticky also and didn't pass out easily and caused much pain. Did this also disturb the healing? I am eating nothing bad. I am eating less and that only grapes, soup and dal and drinking atleast 3 litres of water per day.
Why is stool sticky although I am having so much water? What can I do to avoid this?
I have had this operation on 1st of April. It's been a month, but I am still in pain. I worry why it has not healed within 3 weeks. How much more time will it take? Some skin was also plucked out from the anus while cutting the sentinel pile out. Had it made the wound deeper and difficult to heal?
One thing I want to tell you that after the operation, I could see my wounds in the mirror by stretching my anus gently. But after 15 days, they were not so visible. Now I cannot see at all either because they are not outside now or because of tightening of anus. The skin there seems to shrink inwards and the ring is also not clearly visible as it was after the operation. Is it a matter to worry about? I think anus has come to its pre-op size.
You said that any surgery now will only increase the wound. Will the dilator without anesthesia also do the same? Should I go for it? Will it help heal the wound or can worsen it also? What might be the cause of my getting so many wounds after operation-misperformed dilation or that thermal cautery device?
And I didn't take isabgol in self-medication. The surgeon I consulted after the surgery told me to take this and all other medicines I took. But when I told him about my condition getting worse after taking this, he asked me to continue which I couldn't. He told me that this would help in the long run. That's why I asked you about that.
Should I continue taking zerodol s and for how long further?
On some days when I feel intense pain during BM, I eat very less because of fear of stool. I mostly take fluids. Won't lactotil harm in that case (if we eat less)?
I am currently applying nifidipine (0.3%) with 1.5% lignocaine and metrogyl p. Are there any other ointments that can work faster or better? Can the tightness of anus be caused by metrogyl p?
Sir, since the motions are sticky, should I take polyethylene glycol based laxative like Movicol. Can you recommend a brand? What should be its dose? How to take it?
I asked about prune juice because I thought it might help me get softer stools.
Can I take cow ghee, milk , butter and jaggery. Will they help?
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?
And sir, can flight travelling affect the fissure?
I had test of ESR and ultrasound of abdomen. They were normal. Should I undergo another tests? I had colonoscopy in 2011 and it was normal. I had non-specific ulcers. They doctors said they were normal.
Since my subscription is soon going to end, I will have to take another one if I want to have further consultation, then in new thread, how can I connect to you? Conversation with another doctor will require me to tell the things from the scratch again whereas you know the whole situation of mine now.
After operation, I took photos of my wounds that were visible in the mirror by stretching gently, would you have a look at them? How can I send those to you?
Sir, can I reach a condition when I can eat everything while not taking any laxative and still not have pain?
Thanks a lot,
Onkar
Brief Answer:
Follow for 1 week only.
Detailed Answer:
Most welcome Onkar, I can understand the plight you are going through. Please do not worry , I am going to try to give you the full explanation and of course some advise which may look odd to you , but this is going to be from the bottom of my heart and out of my long practice dealing with such cases; I will try to correlate a small wisdom I have collected over the years.
Well back to your queries and history.
Healing:: let us try to forget what happened in the past except for the probable findings and those things which will help for you to get disease-free. Please try not to pick me up by the words..
Disturbing means= Give it a time to heal naturally. Body only heals the wounds , we just assist in the healing process. You are not having any HARD stools, so stop worrying about the laxatives part of the story.. Take a single one which you are already taking as it is helping.
Every Doctor's in particular Surgeon's opinion will differ as per their learning and experiences. In your case: now is the time that you should have ''well-formed'' stools for the natural dilatation to occur, albeit they should be soft, which they are. I advise my all patients with the problems like yours to take a full home-made food/ diet (except for which they know they are allergic to). Take everything which you know suits you well. Do not bother about the consistency. Only avoid those foods which you know can cause constipation in YOU alone.
The pain is not due to consistency of the stools. The pain is basically due to the area of the wound which is in one of the most sensitive parts of the body. During healing the sensitive nerve fibers overgrow as a natural process. Once they are covered by the skin, pain will go away.
Sticky stool is again the body's natural process, so do not worry about it.
Dilatation is to be done only after the pain is gone and healing is complete.
Zerodol to be taken only if pain.
Temporary colostomy is not necessary and NOT to be thought of.
You can travel by flight.
You can please ask the moderator, or can write my name- may be a you can specifically ask for a particular Doctor if you want to put in further queries.
You can definitely post photos, we have this very good facility, but they should be of a good quality.
TO SUMMARIZE AND TO ADVISE / or a small exercise for you to follow at least for one week at least : I an not guarantee you but helps all my patients.
*
Start eating everything which suits you, do not worry about anything else. The stools must be well formed but a bot soft; continue Lactotil in the doses which you must have learnt over the time.
Stop applying everything to the local area. ONLY xylocaine jelly to inserted and nicely smeared 5 to 10 minutes before passing motion.
Sitz bath: they are the most important and to be done correctly:
The tub must be really big to accommodate you ( the buttocks) comfortably. The height should not be much. You should be seated without strain to the bottom and body. The water has to comfortably warm and to be tested with the back of the palm for temperature. If needed put extra water on the stove to be added as the water gets cold pretty fast. Sit for at least 10 minutes. This is the first thing to do the moment you get up from the bed. Repeat this before passing motion if you have the habit to pass motion after some time. Repeat after passing the motion. and at least two to three more times in the day till you sleep.
Follow for 1 week only.
Detailed Answer:
Most welcome Onkar, I can understand the plight you are going through. Please do not worry , I am going to try to give you the full explanation and of course some advise which may look odd to you , but this is going to be from the bottom of my heart and out of my long practice dealing with such cases; I will try to correlate a small wisdom I have collected over the years.
Well back to your queries and history.
Healing:: let us try to forget what happened in the past except for the probable findings and those things which will help for you to get disease-free. Please try not to pick me up by the words..
Disturbing means= Give it a time to heal naturally. Body only heals the wounds , we just assist in the healing process. You are not having any HARD stools, so stop worrying about the laxatives part of the story.. Take a single one which you are already taking as it is helping.
Every Doctor's in particular Surgeon's opinion will differ as per their learning and experiences. In your case: now is the time that you should have ''well-formed'' stools for the natural dilatation to occur, albeit they should be soft, which they are. I advise my all patients with the problems like yours to take a full home-made food/ diet (except for which they know they are allergic to). Take everything which you know suits you well. Do not bother about the consistency. Only avoid those foods which you know can cause constipation in YOU alone.
The pain is not due to consistency of the stools. The pain is basically due to the area of the wound which is in one of the most sensitive parts of the body. During healing the sensitive nerve fibers overgrow as a natural process. Once they are covered by the skin, pain will go away.
Sticky stool is again the body's natural process, so do not worry about it.
Dilatation is to be done only after the pain is gone and healing is complete.
Zerodol to be taken only if pain.
Temporary colostomy is not necessary and NOT to be thought of.
You can travel by flight.
You can please ask the moderator, or can write my name- may be a you can specifically ask for a particular Doctor if you want to put in further queries.
You can definitely post photos, we have this very good facility, but they should be of a good quality.
TO SUMMARIZE AND TO ADVISE / or a small exercise for you to follow at least for one week at least : I an not guarantee you but helps all my patients.
*
Start eating everything which suits you, do not worry about anything else. The stools must be well formed but a bot soft; continue Lactotil in the doses which you must have learnt over the time.
Stop applying everything to the local area. ONLY xylocaine jelly to inserted and nicely smeared 5 to 10 minutes before passing motion.
Sitz bath: they are the most important and to be done correctly:
The tub must be really big to accommodate you ( the buttocks) comfortably. The height should not be much. You should be seated without strain to the bottom and body. The water has to comfortably warm and to be tested with the back of the palm for temperature. If needed put extra water on the stove to be added as the water gets cold pretty fast. Sit for at least 10 minutes. This is the first thing to do the moment you get up from the bed. Repeat this before passing motion if you have the habit to pass motion after some time. Repeat after passing the motion. and at least two to three more times in the day till you sleep.
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Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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