Resolved question:
Hi, I am suffering from chronic anal fissure, which became chronic after diagnose, about 4 months ago. I tried using many creams and OTC drugs. I was later penciled in for a surgical cure. But soon, I got a second opinion, to use Diltiazem, as per the recommendation of the consultant. I was using it for the next 2 weeks. This resulted in gradual development of the situation. But suddenly, today it become worse and started getting severe. What can be the cause of this? Should I continue with using Diltiazem? I have a medical history of chronic fatigue about 14 years and was unable to do works. Now I am able to do works, but I fear that a surgery can put me again down to bed. I am also a diabetes patient with type 1 diabetes. Is sticking with Diltiazem improve my situation? I heard that recurrence of fissure is a common thing. Please help.
Submitted:
4 Days
Category:
Sexologist
Thank you for consulting with us. I understand that you have been having an anal fissure for the past 4 months. For a surgeon, one of the most common diagnoses made in the clinic is that of anal fissure but only 10-15% of patients require surgery. Therefore, even though you have had the problem for 4 months now, I think your problem can be managed with Diltiazem at least for 8 weeks twice a day before declaring the therapy a failure. The mode of application of Diltiazem ointment is also very important. It should be applied into the anal canal with the help of a disposable glove and avoid washing yourself or passing stool for half hour after application. If you are experiencing a headache due to Diltiazem which is common due to systemic absorption of the drug, you can take Paracetamol. I'm sure if you follow this regimen, your symptoms will be relieved considerably. I want to reinforce that your diet also needs to change to avoid difficulty in passing stools. Alternatively, you can use bulk forming agents like Ispaghula husk. For pain relief, ask your doctor to prescribe a local analgesic cream. Surgery is an option for patients whole symptoms have not been relieved for 2 to 6 months of non-surgical treatment. Also, you could try taking Sitz baths with warm water and salt with about 3 ml of Savlon. Keep your anal areas clean using wet wipes every time you have to use the bathroom. If all this has failed, the next step is surgery. Lateral sphincterotomy is performed mainly because of the ease of the procedure itself. But nearly 40% of patients suffer form some degree incontinence of flatus and when you get diarrhea. A V-Y flap basically covers up the defect caused by the fissure. A newer procedure which has met with considerable success is a combination of Botox injection and VY surgery. The Botox paralyses the muscle of the anal canal allowing for temporary healing. As you suffer form chronic fatigue syndrome, your recovery from any surgery will be delayed. But these surgeries are not so radical and you will recover in a reasonable time. Hope this information was of use to you.