Suggest Treatment For Constipation And Pain In The Anal Area

Brief Answer:
Most likely its hemorrhoid.

Detailed Answer:
Hi There ,
Thanks for choosing HealthcareMagic for your query.
I am Dr XXXXXXX and would be addressing your query.

As per the history given by you most likely cause of your problem is Hemorrhoids. Hemorrhoids are swollen veins in the lowest part of your rectum and anus. Sometimes the walls of these blood vessels stretch so thin that the veins bulge and get irritated, especially when you poop.This can be as a result of trauma experieced by abdominal structures during childbirth.Sometimes hemorrhoids prolapse(as in your case), or get bigger and bulge outside the anal sphincter. Then you may be able to see them as bumps that are pinker than the surrounding area. Today, the theory of sliding anal canal lining is widely accepted.This proposes that hemorrhoids develop when the supporting tissues of the anal cushions disintegrate or deteriorate(in your case due to trauma experieced during child birth). Hemorrhoids are therefore the pathological term to describe the abnormal downward displacement of the anal cushions causing venous dilatation.
According to standard texts Hemorrhoids are classified as-
Grade 1:hemorrhoid bulges into the canal but does not prolapse or fall completely into it. These may bleed.
Grade 2: hemorrhoid protrudes past the anal verge with straining for a bowel movement or passage of flatus, but spontaneously return to their original internal position once the straining has subsided.
Grade 3: the hemorrhoid may protrude past the anal verge without any straining and requires the patient to push them inside manually.
Grade 4: the internal hemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm.
Your case is grade 2 hemorrhoid.

Three types of managements are there
1)Conservative
2)Non invasive
3)Invasive surgical

Initially we start with conservative management for at least 3 months-
Suggestion for conservative management are-

Start taking Syp. Lactulose 10-15ml once daily before going to bed. It is one of the most frequently used laxatives, tolerated very well by patients in long terms with minimal side effects. Using laxative would prevent straining while defecating.

-Secondly, start using Prepration H (a combination containing contains Calcium Dobesilate, Hydrocortisone, Lignocaine, and Zinc.) locally over the prolapsed hemorrhoids.

Thirdly, request your gastroenterologist to prescribe you with oral Calcium Dobesilate-Doxium therapy for 3 months. Initially twice daily for 21 days followed by once daily for 10 weeks. Trials have shown that 3-month therapy can cause shrinkage of Hemorrhoids in almost 60% cases.It was demonstrated that calcium dobesilate decreased capillary permeability, inhibited platelet aggregation and improved blood viscosity; thus resulting in reduction of tissue edema.

Add Metamucil/Fybrogel to your regimen. It's a natural laxative containing husk. It absorbs water from the intestine and swells up making passage of stool easy and add bulk to stool.Take it 2 tsf twice daily with half cup of XXXXXXX warm milk.

-A probiotic like VSL#3 should also be taken regularly with these medicines. Probiotic improves overall digestion and help in formation of smooth stools easier to pass.

Oral flavonoids: These venotonic agents were first described in the treatment of chronic venous insufficiency and edema. They appeared to be capable of increasing vascular tone, reducing venous capacity, decreasing capillary permeability, and facilitating lymphatic drainage as well as having anti-inflammatory effects
However, if not relieved even after 3 months of aggressive therapy proceed for Rubber bands ligation- inexpensive and are easy to deploy. It's a day care procedure usually done under local anesthesia. The success rate varies from about 70-80%.

Strict lifestyle modification should be followed along with medications-

Take simple organic and vegetarian home cooked low-fat food for few days.
Avoid alcohol, smoking aerated beverages, junk food like pizza burger etc.

Take lots of probiotic rich food like yogurt.
Increase your fiber intake take oats, wheat, barley, vegetable and fruit like Pear, apple, and oranges.

No aerated beverages.
Take fiber containing easily digestible food.
Avoid red meat.
Drink a glass of lukewarm water before going to the washroom in morning.
Taking Sitz bath will help.

If not relieved by it in 3 months then Noninvasive methods are tried like-

1)Sclerotherapy: This is currently recommended as a treatment option for first- and second-degree hemorrhoids. The rationale of injecting chemical agents is to create a fixation of mucosa to the underlying muscle by fibrosis.

2)Rubber band ligation: Rubber band ligation (RBL) is a simple, quick, and effective means of treating first- and second-degree hemorrhoids and selected patients with third-degree hemorrhoids. Ligation of the hemorrhoidal tissue with a rubber band causes ischemic necrosis and scarring, leading to fixation of the connective tissue to the rectal wall.

3)Cryotherapy: Cryotherapy ablates the hemorrhoidal tissue with a freezing cryoprobe. It has been claimed to cause less pain because sensory nerve endings are destroyed at very low temperature.

In case if this is not successful then we have invasive surgical procedures like-

1)Hemorrhoidectomy: Excisional hemorrhoidectomy is the most effective treatment for hemorrhoids with the lowest rate of recurrence compared to other modalities.Success rate is more then 90%.

2)Stapled hemorrhoidopexy-A circular stapling device is used to excise a ring of redundant rectal mucosa proximal to hemorrhoids and resuspend the hemorrhoids back within the anal canal. Apart from lifting the prolapsing hemorrhoids, blood supply to hemorrhoidal tissue is also interrupted.
Initially go for digital and proctoscopic examination by a general surgeon and see what he says.
Hope I provided you with the information you wanted.
In case you need further advice feel free to ask.

Regards

---

Brief Answer:
Follow up.

Detailed Answer:
Hello,
In picture it looks like Hemorrhoid only but before starting treatment a in person physical examination should be done by a general surgeon along with proctoscopy.
Secondly you need to get a prescription for Calcium Dobesilate but breast feeding is a contraindication for use of calcium dobesilate.

Apart from that all other things can be taken.Most likely you would feel much better in 3 months.
Continue taking lactulose for 3 months.Don't worry its very safe and will help your condition a lot.

Tell me after 21 days how are you feeling.

Regards

---

Brief Answer:
Follow up.

Detailed Answer:
Hello again,
Thanks for follow up.

Internal hemorrhoids are painless.Very rarely do they present with pain.
As per the classification given above most likely your hemorrhoids are in grade 3 right now(protruded outside).
See if you follow the medical therapy and life style modifications for three month then sucess rate is about 50-60% and possibilities are there that hemorrhoid sheds away or is shrinked.
Main problem in your case is that as you are breast feeding your child the main stay of the therapy Calcium dobesilate can't be given but still you can give others a try for 3 months.

Yes if not treated properly then they will hang out permanently out of your anal canal(Grade 4 hemorrhoid) and you have to go for non invasive or invasive surgical procedures.
Years can't be predicted but if not intervened properly will take about 18 to 24 months appoxiamately.

Follow what ever i advised you would feel much better in 3 months once you stop breastfeeding calcium dobesilate would also be added to your regimen.

Dont worry.Have faith in me.
Hope i answered your query well.

Thank you!

---