How to treat itching and incontinence after anal fissure surgery

Anal fissure is a tear or a crack in the lining of the anus, which affects people of any age and gender.

The most common reason people develop this condition is because of trauma or injury. Chronic constipation, passing out a large stool, explosive diarrhea, and child birth can cause the anal canal to stretch and tear.

Other less common causes are anal intercourse, rectal exam, and insertion of a foreign body into the anal canal. A fissure may also occur in patients with anal cancer and Crohn’s disease.

An anal fissure can heal on its own. However, some people may need to undergo a series of treatments.

With the help of medical treatments, acute fissures can heal within a span of four to six weeks. Whereas, chronic fissures may last for more than six weeks.

Non-surgical Treatments

• Fiber therapy. Fiber softens and adds bulk to the stool. Consuming a high fiber diet will prevent excessive anal distention, which could cause further tearing of the fissure.
• Sitz bath. This relaxes and improves blood flow inside the anal canal. A patient will be asked to seat in a tub or sitz bath filled with warm water for about ten to fifteen minutes twice or thrice a day.
• Laxatives. A laxative helps soften stools and move bowel fast to prevent patient from being constipated.
• Topical Nifedipine. The gel form of Nifedipine is applied directly to the fissure to reduce the pressure inside the anal canal.
• Topical Nitroglycerin. A pea-sized of Nitroglycerin ointment is applied around the opening of the anus to improve blood flow and decrease the pressure inside the anal canal.
• Anesthetics and steroids. These drugs are used to relieve inflammation and pain.
• Botulinum Toxin. A low dose of this toxin is injected into the internal anal sphincter to cause temporary muscle paralysis, which can last up to 3 months.

Surgical Treatment

Lateral Internal Sphincterotomy is the surgical procedure of choice for the treatment of anal fissure as recommended by the Standard Task Force of the American Society of Colon and Rectal Surgeons.

In this procedure, an incision is made into the internal anal sphincter to relax the muscles in it.

The surgery does not take long, and patients normally continue with their activities within a week.

The common concerns of patients after surgery include incontinence and itching at the incision site.

Fecal or bowel incontinence is the inability to control bowel movement. This causes unexpected passage of stool and gas from the rectum.

On the other hand, itching may result from the wound healing process.

Management of Post-Surgery Itching and Incontinence

• Add fiber to your diet.

Fiber-rich foods include bran, beans, berries, whole grains, nuts, and green leafy vegetables.

• Increase your fluid intake.

Drinking 8 or more glasses of water and other fluids each day will help you prevent constipation.

• Increase your physical activity.

Devout at least 30 minutes of your day to exercising. This helps improve blood circulation, and it will also prevent constipation.

• Avoid straining during a bowel movement.

Don’t use too much pressure when you are passing out stool to prevent your incision site and your internal anal sphincter to tear.

• Keep your anal area dry.

Wetness or moist anal area will only make irritation worse.

• Sit on a foam or gel-filled pillow.

This may help alleviate the pain.

You can also ask your doctor to prescribe a topical ointment to relieve pain and itchiness. Additionally, avoid rubbing or scratching the affected area as this can cause further irritation.