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Fissure treatments to select from

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I need some urgent expert advice for my severe and embarrassing situation. I have been suffering from fissure for the last 4 months. I tried many creams and OTC drugs, which haven't helped me. Now the situation has become worse and chronic. I consulted with 2 private consultants who themselves had different and opposite opinions each other. Their decisions seem to be just opposing one another. One suggested a VY advanced flap surgery for me. The second one told that it is not safe and suggested Lateral internal sphincterectomy. I know draw backs of each. The first one seems to be risky and sever and the second one seems to develop continence issues. Which one is more effective for me? I would like to know about the various risks associated with both of these procedures. I am married and have 2 small children. I am breast feeding the second one still. So, I cannot take all drugs. What is the best option in your opinion? Please help me. Thanks.

Category: Sexologist

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Category: Family Physician-GP
 23 Doctors Online

Thank you for consulting with Doctorspring. I understand that you have been worried about anal fissure which you think has become chronic causing pain and discomfort. It has also left you confused as to which surgery to opt for. Fissure is a common surgical problem but only 10-15% of patients actually need surgery and benefit form it. I'd like to know what your doctor prescribed before you were told that you may need surgery. I still think that a trial of no surgical methods would help you. Surgical procedures are generally reserved for people with anal fissure who have tried medical therapy for at least one to three months and have not healed.

Firstly, try taking more fibre in your diet including fresh fruit, oat bran, and porridge. Increase your intake of water and try to walk at least for 10 to 15 mins after every meal. You could try Regulan (isphagula husk) and follow the instructions on the carton.

Secondly, to relieve pain, a local anaesthetic cream could be tried. This is safe even if you are breast feeding.

Thirdly, you could try Diltiazem 2% ointment. It has to be applied into the anus with the help of a disposable glove. This should be continued for 2 times a day for 8 weeks. Some people get a headache with this which will go away if you take an analgesic like Paracetamol.

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.

I would suggest that you bring up these issues with your surgeon and ask him whether you could have a trial of non-surgical management and discuss with him the option of Botox with VY plasty. I hope this information is useful to you.

Dr. John Monheit
Category: Family Physician-GP
Residecny: North Colorado Family Medicine
Medical School: The Chicago Medical Center
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