1. How do I know that I have an Anal #Fissure?
Fissure-in-Ano presents as episodes of Pain & Bleeding while passing Stool. People who suffer, tend to be well aware & usually self manage by alteration in the food & bowel habits to avoid the painful bowel movement. The usual duration of symptoms is 10-15 days, followed by gradual improvement only to recur again in about 3-4 months.
Typically, this happens 3-4 times every year until medical opinion is sought.
2. What is better, Liquid or Bulk forming #laxatives?
During an acute painful episode, its unwise to increase in stool bulk, thus Bulk forming laxatives are best avoided during ACUTE EPISODE. Here laxatives like Liquid Paraffin, Lactulose, Lactitol can be used. Once the episodes settle and there is no spasm, Ispaghula Husk can be used.
3. Which #Ointment is best?
There are numerous Ointments with a wide variety of Drug combinations available. Its best to use one after a complete Surgical Consultation. All these would contain some numbing agent, a muscle relaxant. Steroid containing Ointments are best avoided.
4. Role of #Sitz Bath?
The concept is to use heat to relax the muscles that have gone into spasm, by sitting immersed in a Tub full of water. Plain heated water (Temperature as per individual preference) works best. No need to add Betadine / Savlon / Dettol.
A frequency of 2 times a day & time duration of about 15 mins is adequate.
5. Is #Surgery the only treatment?
Only about 5% patients need Surgery, which means 95% times a surgery can easily be avoided. A thorough evaluation using our concept of Personal Space Surgery & a curated treatment can help avoid a Surgery in great majority & achieve optimum results when Surgery is necessary. The Surgery described is called as #LateralInternalSphincterotomy. It can be performed in Open or Closed fashion.
6. Would the surgery hamper the control of Stool (Continence)?
Lateral Internal #Sphincterotomy is division of the internal (Autonomous) muscle that results in relief from Spasm & narrowing. The External Sphincter remains intact. More so the defect in internal muscle gets bridged by fibrosis in due course of time. Thus, any clinically significant incontinence to Stool or Flatus is rarely encountered.
7. How useful is #Botox Injection in treatment?
Botulinum Toxin (Botox) has been used to relieve the spasm of the Internal Sphincter by injection into the muscle causing temporary paralysis (Up to 6 months).
However, the biggest issue (Side effect) with use is that if both (Internal & External) sphincters get paralyzed, there will be incontinence to stool which cant be reversed by any means & may take up to 6 months to recover. Due to safer alternatives, its not routinely prescribed.
8. What is Key-Hole Defect?
It’s a complication when a Surgeon chooses to do Lateral Internal Sphincterotomy through the Fissure itself or performs a Fissurectomy. The Fissure behaves like a chronic wound with precarious blood supply. The wound thus may never heal and result into a permanent defect. Thus, the sphincter division is performed at sides (Lateral) rather than front or back & Fissurectomy should be avoided.
9. Can it recur?
Very rarely, esp. if the constipation-bowel habits & diet changes haven’t been followed up. These changes to be followed are not temporary but lifelong. Even if there is recurrence, once the surgery is done the fissures tend to be very mild
10. Cost of Surgery & details?
The recommended surgery is Examination Under Anaesthesia with Lateral Internal Sphincterotomy. The usual cost would be about 45-50 thousand in a Single Occupancy Room. The usual length of stay is 1 day. Resumption of Daily routine & Diet is from next day. There is no wound that needs any complex dressings.
If you suffer from Anal Fissure symptoms, have been diagnosed or advised Surgery for the same schedule an appointment with Dr Vishal Soni @ Zydus Hospitals, Ahmedabad, Gujarat for evaluation & treatment options.
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