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Dr. Andrew Rynne

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Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 17733 Questions

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Posted on Fri, 23 Sep 2016 in Digestion and Bowels
Question: Hello Doc, suffering from piles since one year . It gets better then happens again whenever the stool is a bit firm . Before piles i had a horrific episode of fissure as well which has healed now but has left a sentinel pile which gets irritated and sometimes bleed . My question is with medication can i ever get to lead a normal life again ? One more thing i have been uaing Anovate ointment since one year . Do Anovate ointment if used for a long term lead to any complications ? Please reply what can i do to get my normal life back again? I am just 27 so i am afraid to get the surgery done for piles .
doctor
Answered by Dr. T Chandrakant 58 minutes later
Brief Answer:
As discussed in details below.

Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
To recapitulate: Male/27 - piles since one year - recurrent with firm stools - fissure left sentinel pile which gets irritated and bleeds - Anovate for one year - pilex oint - has many questions...
Let me take up you questions one by one and explain:
My question is with medication can i ever get to lead a normal life again?
>Certainly yes, you can get your normal life back again; but this can not be conditional as you say with medications alone.
We have to find the root cause, its secondary effects and treat them together.
I would advise you the following in such a situation:
- First of all, consult a General Surgeon to get a clinical evaluation, per-rectal digital examination and ano-proctoscopy to get the exact diagnosis. Without knowing the exact diagnosis and the severity/grade it is difficult to predict the best possible treatment for you.
- Sitz bath in a tub with warm water.
- Mild laxatives and the dosages to be adjusted as per your requirements.
- Make a list of the foods and beverages that cause constipation or enhance your problems in any way and to stop them altogether strictly.
- Make another list of the foods and beverages that suit you the best and continue those alone. Do not try anything out of ordinary.
- Control of stress and anxiety if you have.
- Keep the area clean with plenty of water after passing motion and in the evening to wash of the sweat; keep it dry and well ventilated when at home. use loose underwear and pants.
- Tests of stool, blood and urine and get a course of an antibiotic and metronidazole if there is any evidence of infection.
- Probiotics and multivitamins help in good recovery.
These measures help a lot in complete recovery and avoiding the recurrence.

Do Anovate ointment if used for a long term lead to any complications ?
> Since it contains steroids, it can make the area thin and easily breakable skin.

Afraid to get the surgery done for piles .
> It depends upon the severity or degree of the problem that decides whether you need surgery. Hence the need of a General Surgeon's opinion as explained above.

Please suggest what do i do to get my normal life back again ?
> As detailed above.

Can i exercise ?
> Certainly yes.

I hope these answers help you clear your doubts and adds on your knowledge to help you in treatment and decision making.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 27 minutes later
Sir thanks for your reply . As you mentioned that extended use of Anovate may cause thining of skin . Can you please suggest some other ointment to apply when in pain and has less side effects ? Because of this problem my life is thrown off track ! Today i ordered Nelson's Hplus ointment after reading its reviews online hoping that it will bring in some relief ! May god bless me soon .
doctor
Answered by Dr. T Chandrakant 40 minutes later
Brief Answer:
Xylocaine jelly can be used when in pain

Detailed Answer:
Actually none of the ointments help as the disease is deep within. It is the combination of all the efforts as discussed above.
I can suggest an ointment only after you give me the correct diagnosis after examination by a General Surgeon.
You can use Xylocaine/Lignocaine jelly when in pain.
Please stop Anovate.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 36 hours later
Hi doctor consulted a colo rectal surgeon and he advised me to undergo surgery as i have failed to respond to conservative methods . Now i am reallly reallly scared that post surgery will i be able to heal and lead a normal life again ever because i read on the internet that ANAL FISSURE SURGERY sometimes causes infection and incontinence also . However doctor still advised me to use Crema gel and gave me lactifiber to take in the night . He said that this is the last trial of conservative method and however the chances of me getting cured with this is really really slim but if i doesnt heal then he will perform surgery . Sir i am just 27 yrs old so pleasee advice should i go ahead with the surgery ? Surgeon also scared me a lotby saying if i dont perform the surgery then it may lead to further complications of abscess and fistula . Looking forward to your genuine suggestion doc .
doctor
Answered by Dr. T Chandrakant 3 hours later
Brief Answer:
Please give exact diagnosis and the procedure he is going to perform.

Detailed Answer:
Hi.
Can understand your anxiety.
Internet gives horrible stories, the virtual word.
You can always talk to someone who has undergone such a procedure in person.

Please give me exactly what was the diagnosis done by the Colo-rectal Surgeon and which procedure exactly is he going to perform if required.
This will help me to assist you further in a better way.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 18 hours later
Sir in the diagnosis doctor has written fissure with sentinel pile at 6oclock and advised is Surgery where he will perform a cut my internal sphincter which will relax the muscle and allow the fissure to heal . Sir i want to know if the procedure is performed then will it cause any complications ? If the procedure really will bring my the happiness back in my life then i wouldnt mind doing it . Also sir please tell me in this procedure will my anus be stitched by the doctor ? I am in a profession where i need to apply my full mind and post development of fissure i havent been really able to do that . Looking forward to your suggestion .
doctor
Answered by Dr. T Chandrakant 51 minutes later
Brief Answer:
as explained in details.

Detailed Answer:
Thanks for your feedback.
So this is posterior anal fissure with sentinel pile and the procedure is called Internal sphincterotomy.
In this procedure a small cut is made into the internal anal sphincter.
One of the causes of a chronic anal sphincter is tight internal sphincter which does not allow the anal canal and verge to open up well hence the stool by means of friction over the tight sphincter causes the anal fissure.
By doing internal sphincterotomy the root cause is treated.
If you also follow the other precautions as discussed above the healing occurs.
This procedure allows the cure.
There is no stitching usually.

Complications: It may allow the passage of gases only and not feces as the external sphincter is kept totally intact so do not worry about incontinence.
Since this is a procedure a small hematoma may occur which resolves well.

To repeat: you also have to follow other additions precautions and care to get the best results out.

So go ahead and you will have the best results.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 19 minutes later
Sir one more question once the procedure is done and i recover after that will the internal sphincter becomes tight again ? Then in that case the chances of fissure recurrence increases ? Sir one more time please considering my age i.e 27 yrs advice me if the procedure will be safe for me ? Will i be able to lead a healthy and normal life again ?

Thanks.
doctor
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
You will have a great life if you follow the principles described.

Detailed Answer:
Thinking too much is also a part of the stress and anxiety, which in itself is one of the major factors in bowel habits/regularity/normalcy and hence formation of fissure and such problems like IBS.
I hope you are getting my point.
So start believing and have faith in someone who is going to operate you. Think that you will be cured, believe me this helps.
If you follow the outlines given in the first answer- please read again.
Sitz bath in a tub with warm water.
- Mild laxatives and the dosages to be adjusted as per your requirements.
- Make a list of the foods and beverages that cause constipation or enhance your problems in any way and to stop them altogether strictly.
- Make another list of the foods and beverages that suit you the best and continue those alone. Do not try anything out of ordinary.
- Control of stress and anxiety if you have.
- Keep the area clean with plenty of water after passing motion and in the evening to wash of the sweat; keep it dry and well ventilated when at home. use loose underwear and pants.
- Tests of stool, blood and urine and get a course of an antibiotic and metronidazole if there is any evidence of infection.
- Probiotics and multivitamins help in good recovery.
These measures help a lot in complete recovery and avoiding the recurrence...

Internal sphincter becomes tight due to the reflex spam due to the constipation, fissure for the first time and recurrence. Fissure and spasm/fibrosis of the internal sphincter are like cause and effect, changing the role every time. Each one increases the role of other and this vicious cycle is broken by the internal sphincterotomy thus giving the chance of cure.
Since you are young the procedure will be safe and the standard sphincterotomy is the most commonly done procedure done by the Colo-rectal Surgeon.
You certainly will lead a healthy and normal life again.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 46 hours later
Hello sir i am undergoing LIS on Friday . The doctor said that he has not seen any patient in the past who after undergoing LIS had again got a fissure . He also aaod u will feel much better after the operation . I asked him sir will i ever feel normal again in life ? At that he said ofcourse Yes !! Sir i wanted to know after the surgery on Friday what all precautions do i have to take for a faster recovery ? And how long will i take to heal ? Please let me know !

Thanks.
doctor
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
All the best !!!

Detailed Answer:
All the best for your surgery and outcome.
Great, that your Surgeon is so confident and means he shall perform the best.
The results are always instantaneous.
..
All the precautions to be taken are already listed in the first answer, please follow them religiously and you will have the best life ahead.

Healing too is very fast as nothing much is cut, may be a day or a few days at the most.

Avoid stress and anxiety at any cost.
Also follow what your operating Surgeon says as he might have something special out of his experiences.
....
Please let me know the follow-up.
You may please rate this answer before closure of the discussion and can certainly contact me on the bellow link in future, whenever you may need me.
http://bit.ly/askdrtchandrakant
Above answer was peer-reviewed by : Dr. Nagamani Ng
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