Last time, I talked about hemorrhoids and how many patients who think they have hemorrhoids actually have another problem. Today, I’ll talk about what those other problems might be.
Probably the most common thing that is confused with hemorrhoids is an anal fissure. The main way that I, as a colon and rectal surgeon, am able to determine that the problem is an anal fissure and not something else is by listening to my patients! I know you may not believe that. I don’t need a fancy X-ray or CT scan or MRI to diagnose an anal fissure. The history told by the patient is almost always enough. So, what is the most common symptom? Anal pain, especially pain that is made worse when the patient is having a bowel movement, is the most common symptom. A common question I will ask patients is, “Do you dread your bowel movements?” If the answer is yes, then an anal fissure is going to be a more common diagnosis than anything else.
How is an anal fissure treated? The first thing that almost everyone needs is more fiber in their diet. I often recommend a fiber supplement, which should be something with psyllium in it. That is either Metamucil™, Konsyl™, or psyllium husk. Other treatment options include a topical cream, such as either nitroglycerin or diltiazem.
However, some patients have a fissure that is causing severe pain or has been present too long to have a chance of healing with just fiber and cream. Those patients are better served with surgery for their fissure. A lateral internal sphincterotomy is the most common procedure done for a fissure and has a success rate of 95%-98%. The downside to this procedure is incontinence. Fortunately, the incontinence is uncommon and when it does occur, is rarely severe.
An anal fissure is one of the easiest problems to treat in my practice. Surgery is short and patients may go back to work typically in only a few days. I see so many patients who say, “I don’t know why I waited so long!”
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