Brief Answer:
First get proper diagnosis of the exact condition.

Detailed Answer:
Hi.
Thanks for your query.

One of the most important issues after delivery is development of anal fissure and / or hemorrhoids.

I would advise you first to consult a General Surgeon to get a proper diagnosis , whether you are suffering from fissure and / or hemorrhoids. There can be a combination of both the problems.
The treatment is bit different for both the conditions, hence the necessity of having a very proper and clear-cut diagnosis which can be done only on clinical actual examination, digital examination and minimum of a proctoscopy examination by an expert in the field

In Anal fissure, there is a lot of pain , burning after applying water to clean, blood can be just smeared on the hard stool or a few drops only. The pain remains for half an hour or more and gets soothing with the Sitz bath. There can be an associated skin tag at the front or back- these are called ''sentinel piles''- they are not true piles, can not be pushed inside anal canal, are a bit firm to hard to touch and mildly painful.

In contrast: the piles ( hemorrhoids) are always painless ( unless thrombosed and prolapsed), Felt as a soft mass only, bleeding sometimes can be alarming. They can be reduced if pushed inside.

So if you want a real good treatment consult a General Surgeon, who can diagnose and give you the Medical treatment as per the final diagnosis.
Please continue Sitz Bath as it helps in both the conditions
Continue Medicines as per prescription of a General Surgeon after a proper diagnosis- insist on proper examination and diagnosis if you want a cure.

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Brief Answer:
Good medical management; Surgery only if required

Detailed Answer:
Hi Madam XXXXXXX
IT is good to know that you have already consulted a General Surgeon.
When there is a combination of both; the treatment remains almost same for internal hemorrhoids and fissure as the cause is same for both the conditions.
I hope the hemorrhoids are not much symptomatic as there is no bleeding and must be grade I or II (if not prolapsing - need no special treatment)

Severe burning pain indicate fissure, which is open. Sitz bath before and after motion is passed, cleaning the area with a cotton ball soaked in the warm water, applying liquid povidone iodine ( batadine) to the peri-anal area helps avoiding secondary infection and relieving discomfort to a large extent.

I hope your Surgeon has prescribed you a course of antibiotic, metronidazole and anti-inflammatory medicines. You can certainly request for pain-killer to be taken before going for motion. Add probiotics and multivitamins.
Have normal full diet ( as against the wrong notion of stopping some foods and spices) you need to gave a well formed soft stool - NOT the liquid one). Adjust the doses of Fermat according to your needs.

Usually The fissure heals well in most of the cases. Only those patients who do not respond to medical management may require a small procedure. It can a Lord's Dilatation under general anesthesia or a small incision of the internal sphincter called internal sphincterotomy. Please discuss this with your Surgeon.

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Brief Answer:
There are safe antibiotics

Detailed Answer:
Yes , I do understand that due to nursing the baby, Your Surgeon would have avoided Antibiotic.
There are antibiotics which can be given safely even in nursing mothers. Please request for a course as this helps in recovery.

Anyway, please follow this and take sitz bath 3 to 4 times. IT soothes the muscles, keeps the area clean.

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Brief Answer:
Better to try dilatation

Detailed Answer:
It is OK Madam XXXXXXX
Thanks for your feedback.

I can understand the pain you are going through plus the Motherhood- no proper timetable of anything.

Not to contradict your Surgeon, but I think it is his experience about lactation and the contraction of the sphincter.

One of the indication for dilation under General Anesthesia is failed Medical management. The Surgeon has already said about the contraction and shrinking of the internal sphincter.

I think dilatation should be given a try. It may help a lot.
Please discuss this with your Surgeon. Please note there are chances of recurrence or not getting sufficient relief, but remember there is more chances that you may be cured at the earliest. 65 % of the patients get a complete cure.
And you will be one of them as you understand and follow the medical management rigorously.

Please go ahead with dilatation after discussion with your Surgeon and family too.

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Brief Answer:
Take the medicines and surgery if it fails.

Detailed Answer:
Good that you took another opinion, just follow the advice and continue medicines.

Your only Worry:
Your Surgery is just a day-care one.
You can feed the baby before you go to the Operation Theater ( OT - my personal opinion), and feed the baby after few hours after the Surgery , when the Anesthetist allows. Please tell the Anesthetist about the breast feeding.

Yes, admission is required as the procedure is done in OT.
This is a Day-care Procedure.

Just go ahead if the medicines do not help.
All the best.

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