An anal fissure is normally the result of the overstretching of the anal mucosa or moist tissue. It can overstretch due to a number of reasons such as passing extra-large and/or hard stools, constipation, low blood flow to the area, excessive diarrhea, dietary choices, and childbirth among others. It is a common condition in infants. There are other less common causes such as anal sex and diseases such as HIV, cancer, syphilis, and tuberculosis. Various treatments for anal fissure exist and will be the first line of treatment a doctor will recommend. However, is the anal fissure does not heal through these, surgery will be the only option.
Preparing for surgery
You will be advised not to take any foods or drink after the midnight prior to your surgery. Your anesthesiologist will give you further instructions such as which medications to take or not to take before you go for your surgery. Blood thinning medications are a good example of the drugs that should be avoided before the surgery. Any related information should be shared with your surgeon in the pre-surgery visits.
You will also be guided on how to do bowel prep. There are a number of bowel preps that can be suggested but they mostly involve a laxative and/or an enema taken the night and the morning before the surgery. Your surgeon may suggest the best time for you to take them depending on what procedure you will be undergoing. You can consult your surgeon for more details on your bowel prep.
What to expect after surgery
The recovery process of the patient greatly depends on the type of surgery he or she underwent. You may start your normal daily routine activities like walking after just a few days of surgery, and it will gradually get better. Such activities prevent the risks of getting pneumonia through breathing and also reduce the risk of a blood clot.
You may experience some difficulties depending on which surgery you underwent. You may experience difficulties in sitting or even taking walks for longer periods of time. Using a comfortable pillow such as a donut pillow may help reduce the pressure on the affected area when sitting down.
Engaging in activities like driving while still on narcotic medications is risky especially taking them while driving because it can seriously cloud your judgement driving.
Depending on the type of operation you underwent, you should be able to get back to your daily activities within one to four weeks after the operation.
Managing pain after surgery
The medications you will take to manage your pain depend on the type of surgery you underwent; very strong or very weak medications should not be used to reduce the pain. Ibuprofen painkiller can be effective in relieving the pain. A good number of narcotic medications have Tylenol in them. Therefore you should not take extra Tylenol if you happen to be taking narcotic medication. However, narcotic medications can sometimes lead to constipation and a prescribed bowel regime should be taken after the surgery. You should also use a stool softener.
Under any normal circumstances, you should be able to continue any home medications the same day you finish your medication unless advised otherwise by your doctor.
Diet & Bowel Care
A bowel regime which contains a stool softener, laxative and fiber supplement will be prescribed for home use. This bowel procedure helps to prevent the anal fissure from coming back and also softens the bowel movements. In case you experience nausea or vomiting as a result of taking pain medication, a nausea medication is prescribed.
There are some over the counter medications that have proved to be effective. Some of them are Miralax, Dulcolax and Senna which can easily be found in most local drug stores. Remember to consult your surgeon before taking any of them.
Drinking at least six to eight glasses a day will help keep your bowel movements regular and soft. A high fiber diet can go a long way in keeping anal fissures at bay. If you were on a high fiber diet as part of the medical treatment, you can resume the treatment after surgery. You should consult a nutritional expert if you are on the dark about what types of food are included in a high fiber diet.
You should consult your doctor if you are having a hard time passing your bowel while also experiencing other symptoms such as nausea or vomiting and abdominal bloating without passing any gas.
Urinating may be difficult after surgery since it strains the affected muscle. However, it is not likely that it will interfere with your recovery process after surgery. Sitting down while urinating can ease the process in men. Urinating while sitting on the bathtub can also do the trick. You will need to visit the emergency department if you still can’t urinate 12 hours after surgery. They will need to perform a certain procedure to empty your bladder.
Warm water is good for relieving pain, soothing the affected area and reduces swelling. It also eases the blood flowing and that speeds up the healing process. Make sure to keep the anal area very clean especially after long calls .Use sitz baths with warm water and be to burn your body. Stay in the bath for 5 minutes and at least take the bath 2-4 times a day for better hygiene. To dry the area, use a hairdryer. Use soft moistened wipes instead of dry tissue papers, which to avoid hurting the area .When drying the affected area, be gentle and careful. Some bloody discharge after wiping are noticed, which is a normal thing and should not worry you. Creams or any moisturizers are not advised unless prescribed. A patient is advised to use pads or rather panty linear in the undergarments for such blood discharge.
Normally, appointments may be booked for you after the operation for up to the next three weeks. In case you are discharged during a weekend, you will be provided with a booking for a business day in the hospital. You can always use direct office assistance in case you can’t reach out for appointments. It’s important for your doctor to follow up as it is part of the recovery process.
- You may experience complications from anal fissure due to inability to heal, from the treatments used or from recurrence. The chances of anal fissure recurring increases if you have had a history of anal fissure.
- Another common complication associated with anal fissure is the inability to heal. An anal fissure becomes chronic if there is no positive response to treatment after a few weeks. The ability to heal may be as a result of the anal fissure extending to the internal anal sphincter muscle interfering with the blood flow to the affected area. It is easier to get a bacterial infection when the anal fissure becomes chronic.
- Treatments used to get rid of anal fissure may also lead to complications. Surgery that is used to treat chronic anal fissure may lead to a mild anal incontinence. It can also lead to uncontrolled wind, fecal loss and fecal soiling. Other complications that the surgery can cause include slow healing of the incision, postoperative pain, abscesses and hematoma or ecchymosis among others.
- Complications that may arise from botulinum toxin or any other related medication include fecal or gas incontinence, bruises around the anal area and blood clotting.