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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How Can Anal Fissure Be Treated?

I am 60 years old and have suffered from an anal fissure for at least 10 years. Constipation is not really a problem. I use metamucil every day and usually have a bowel movement daily. The fissure just will not heal. It feels better for a few days then back to being very painful. I have been using hydrocortizone cream with lidocaine but recently was told that long time use is not good and can thin the skin. I wonder if this has happened. What do you suggest and can I use just lidocaine on it for pain?
Mon, 22 Jul 2019
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General Surgeon,  's  Response
Hi,

Noted that a 60 year old patient has chronic fissure in ano with painful defecation and using hydrocortisone and lidocaine ointment locally, stools are not hard.
The commonest causes I can think about are as follows:
Thinning of skin due to use of steroid ointment.
Intestinal infection that has not been diagnosed or treated well.
Local problems like Crohn's or so.
Hence I would advise you the following in such a situation:
First of all, consult a General Surgeon or a Proctologist for per-rectal examination and ano-proctoscopy followed by colonoscopy and biopsy of the colon and affected area.
Tests of stool for three consecutive days.
Tests of blood for diabetes and as needed.
You may need a prescription based antibiotic, metronidazole and probiotics.
Anal dilatation can help to relieve the anal sphincter spasm is present and being the commonest cause.
Avoid stress and anxiety as these are known to cause IBS and such problems.
If a specific cause is found then this can be treated well.
Add on multivitamins, mineral and trace elements for good healing.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. T Chandrakant, General Surgeon
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How Can Anal Fissure Be Treated?

Hi, Noted that a 60 year old patient has chronic fissure in ano with painful defecation and using hydrocortisone and lidocaine ointment locally, stools are not hard. The commonest causes I can think about are as follows: Thinning of skin due to use of steroid ointment. Intestinal infection that has not been diagnosed or treated well. Local problems like Crohn s or so. Hence I would advise you the following in such a situation: First of all, consult a General Surgeon or a Proctologist for per-rectal examination and ano-proctoscopy followed by colonoscopy and biopsy of the colon and affected area. Tests of stool for three consecutive days. Tests of blood for diabetes and as needed. You may need a prescription based antibiotic, metronidazole and probiotics. Anal dilatation can help to relieve the anal sphincter spasm is present and being the commonest cause. Avoid stress and anxiety as these are known to cause IBS and such problems. If a specific cause is found then this can be treated well. Add on multivitamins, mineral and trace elements for good healing. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. T Chandrakant, General Surgeon