HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Suggest Treatment For Persistent Anal Fissure

Posted on Fri, 16 Jun 2017

Question: Suffered from an anal fissure for 5 months and then had botox which Surgeon said healed it. it is 3.5 months after healed and the fissure pain is gone, but still having a dull ache near tailbone and some muscular residual that is better when asleep and then comes back during the day. It's as if the muscle and nerve endings have not fully simmered down yet. Not sure if this is from the botox or if it's worse because of the anxiety this condition causes. When I think it will go away and will not last makes it easier to deal with for now. I was told it could take 3-6 months until this fizzles out and maybe longer if stressed. The Surgeon performed an anoscopy exam when performed botox and nothing else other than 2 internal hems he said so should keep getting better and better?! No other symptoms really. Except this constant feeling that there is something there and not sure what is causing this feeling, The muscles are too tight, and the nerves are hyperactive and need to settle down? undertanding what the feeling is coming from will help to know it will go away. He did not find any tumor or anything and no real stomach pain etc. So what a weird condition. Just need to know this will go away...Waiting for response... Just wondered why the area takes so long to heal and why these muscles also take so long to go back to normal...?

Answered by Dr. Klarida Papaqako (42 minutes later)

Brief Answer:
Explained the mechanism of action of Butilinum toxin injections.

Detailed Answer:
Hello,

Thank you for using Healthcaremagic to post your health query.
I read carefully your question and I understand your concern.

I am glad that this treatment worked well for you and you have improved a lot.
Botulinum toxin injections are also called chemical sphincterotomy, which means
that the toxin of botulin induces a relative hypotonia, which reduces the anal canal pressure while in rest. The cause of having that feeling is because the toxin binds to presynaptic nerve terminals, preventing the neurotransmitter to pass through.
So, the nerves are involved, and the nerves need a time of 4-6 months to be fully reactive.

Now, in about 50% of cases patients will restart having the fissure again after a time with this treatment, but the good news is that the re-treatment is still successful.

My advise is that as soon as it doesn't get worse, then you are in the right path.
Continue to take care of your diet to avoid constipation and be well hydrated by drinking plenty of fluids.

Hope this is helpful.
Let me know if you need more clarifications.

Regards,
Dr. Papaqako

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Klarida Papaqako (1 hour later)

Oh yes thank you... i see so it is the nerves that are affecting the muscles and giving that dull achy feeling higher up, and that's makes sense as to why as time goes by it feels better, it almost makes you feel like you have to have a bm all of the time and the connective muscles are sore from this, I kept reading about levator ani but I DID have a physical cause to these symptoms. ,, and yes it is def better all of the time but slow improvement notice the improvement month over month versus weekly. But def way better. Thank You so much... just knowing there is an explanation for this is helpful Once this is gone i will feel great!!!

Answered by Dr. Klarida Papaqako (3 minutes later)

Brief Answer:
Glad to have been of help

Detailed Answer:
Hello,

I am glad to have been of help and to reassure you.

Feel free to follow up with me when you want.

If you don't have other questions or concerns about this issue, please kindly close and rate the answer.

Regards,
Dr. Papaqako

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Klarida Papaqako (1 hour later)

Quick Question, so it will not hurt anything to sit, it feels uncomfortable and sore when sitting Possibly from protecting it for so long when the fissure was at it's worst. Since all of the muscles are connected could this be why the levator muscles wrapped around the rectum area and connect to tailbone could also be giving a sore pulling up feeling as well? TYpically how long until this fizzles out as well? Same time frame 3-6 months possibly? Thank You

Answered by Dr. Klarida Papaqako (14 hours later)

Brief Answer:
Yes, it will need 4-6 months too.

Detailed Answer:
Hello,

The nerves control the muscles, and of course that that feeling is related to the muscles as well. It depends also on the fact if the bowel/rectum is empty, if you are relaxed and rested.
Yes, it still need 4-6 months to get completely better.
It may have also the opposite effect and the fissure comes back, because the relaxing effect of the treatment will be gone. In this case you just need to repeat the treatment.

Hope this answers your questions.
Let me know if you have other questions or concerns.

Regards,
Dr. Papaqako

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Raju A.T