ANAL FISSURE TREATMENT & SURGERY NYC
AWARD-WINNING, NATIONALLY TRUSTED ANAL FISSURE SURGEON
Anal fissures are small tears in the external skin of the lining of the anal canal. Anal fissure symptoms include bleeding, discharge, pain, and/or the development of a localized skin tag. We provide specialized care for caring for and closing anal fissures. Visit our NYC office or give us a call for more information.
Anal Fissure Surgical Treatment
The most commonly used surgery is a fissurectomy, in which the chronic scar tissue and skin tag is completely excised or cauterized to encourage closure. This helps prevent complications like bleeding after anal, allowing new healthy tissue to form with the support of medical management. A lateral internal sphincterotomy is not advised in clients who engage in anal intercourse, as this procedure can cause future complications limiting sex, as well as incontinence. In the anal sex community, most fissures are more from trauma related injuries than actual muscular tightness.
During the procedure, the muscle is dilated with surgical dilators, and depending on the client, anal botox is used to improve healing. Botulinum is injected into both the fissure line, as well as the internal sphincter, to allow for just enough relaxation during the healing process. This will also help post anal fissure surgery, making sure this relaxation is utilized to our advantage when you start dilating with butt plugs post-surgery; all in the hopes of returning to anal engagement if one desires.
ANAL FISSURE SURGERY RECOVERY
SHORT-TERM RECOVERY
The majority of clients tell us they should have undergone this surgery much sooner, since the recovery is no different than the traditional recovery one goes through when they get their anal fissures. The standard course post-surgery is 2-3 days of primarily constant pain and irritation. Prescription pain pills are utilized, along with lotions, suppositories, epsom salt baths, and stool softeners. The use of a bidet for cleaning purposes can also be beneficial. Honestly, the use of non-steroidal medications, like Advil or Ibuprofen, are the best for diminishing this kind of pain.
Most clients will use these meds more religiously the first few days post-surgery. It then becomes more so during bowel movements over the subsequent 1-2 weeks. At this point, the Botox is fully on board, decreasing the overall pressures during defecation, which leads to diminishment of this painful process. Finally, by the 2-3 week mark, we have entered a really nice healing phase. Now, the initial postoperative visit is 3-4 weeks post surgery. During this visit, a chemical called silver nitrate is placed to encourage appropriate cleaning of the wound and allow for appropriate scar to be laid down. This will give us that tough scarring to withstand all pressures in the subsequent weeks.
LONG-TERM RECOVERY
Once the short-term recovery is complete, we then switch from using all lotions and suppositories to using nothing other than exfoliating soaps. Now that one feels more comfortable in the region, we can start to get more aggressive with the cleaning to encourage appropriate closure. We should mention that during all the time leading up to this, most people place a gauze in the anal region to catch some mucus and discharge. Though it lessens as time marches on, it’s common to still have some mild drainage up until you see us for the first visit.
Once the chemical is placed in the office, this clears up to allow full internal evaluation during the second postoperative visit. A full internal evaluation is performed and another round of this chemical is applied, if it is deemed necessary. During this inspection, we go over the next steps of using at-home butt plugs to help us get over the finish line. These are imperative as it will allow strong, yet distensible, scar growth. This key exercise is what other surgeons are missing.
Postoperative Anal Dilation
The post-operative dilation and work we do is imperative to success of this operation. It takes two to tango here and we want our clients to make sure they understand this is a symbiotic relationship. Of note, most people are about 80-95% healed by the 6-8 week mark. This then brings us into the final stretch- literally. The next month is all about anal play with a set of butt plugs. There isn’t a huge time commitment, but it does require 2-3 times a week with a 3-5 minute session each time, either mechanically or sexually, to get friction across our scar line.
This encourages strengthening, distention, and forming aesthetics. The best part of all is the Botox, which is helpful for getting you back to bottoming not only quickly, but also efficiently. Finally, by the end of the second month, you will be back and beyond where you want to be on the defecation and sexual front. Of course, fisting and larger toys will take a little longer. During this entire process, Bespoke Surgical has an in-house physical therapist who specializes in the pelvic floor, which will help you achieve all these milestones and goals. It’s a long, but necessary process to set the stage for successful engagements and planning for the longevity of the future.
Non-Surgical Treatment for Anal Fissures
The appropriate initial regimen to treat an anal fissure consists of:
- Over-the-counter stool softeners, such as Colace, three times daily
- Over-the-counter fiber supplements, such as Metamucil
- Calmol-4 suppositories twice a day, found at small local pharmacies such as C.O. Bigelow, New London Pharmacy, or Capsule Pharmacy
- Sitz baths, utilizing over-the-counter epsom salts
- A small pea-size drop of Lidocaine 2%/Anusol 2.5%/Cardizem 2% topical ointment should be gently applied by fingertip to the anal opening before bed, in the morning, and after each bowel movement. This compound can be obtained solely by prescription at Capsule Pharmacy in NY
- Boosting your fiber intake with choices such as grains and whole-grain products, fruits, vegetables, legumes, nuts, and seeds
- Increasing your overall water intake to 8-12 ten ounce glasses per day
- Refraining from caffeinated beverages, as they tend to cause dehydration
- Keeping the anal area clean and dry. Wash gently with warm soapy water, and hairblow dry
- Limiting the use of toilet paper, as wiping causes local inflammation. Please refrain from using baby wipes or medicated pads since this prevents healing from its harmful chemicals
- Anal pathology takes time to heal. You can imagine that every time it is attempting to improve, another local trauma/bowel movement occurs. Do not try to avoid having bowel movements, and try not to get frustrated as you work on the above regimen
What is the best anal fissure treatment?
The best treatment for anal fissures depends on the severity of the condition. Initial treatments often include dietary changes, topical ointments, and warm baths to relax the muscles and promote healing. In more persistent cases, Botox injections or minor surgical procedures may be necessary to fully resolve the issue and prevent recurrence.
How long does it take to recover from anal fissure surgery?
It typically takes 2-4 weeks to recover from anal fissure surgery, depending on the individual and the type of procedure performed. Many patients can return to normal activities within a few days, but may experience some discomfort during bowel movements for a short time.
What should I expect after anal fissure surgery?
After anal fissure surgery, you can expect some mild discomfort, especially during bowel movements, which should improve within a few days. You may be prescribed pain medication and advised to take warm baths to help heal and reduce discomfort.
What can I eat to help with anal fissures?
To help with anal fissures, boosting your fiber intake is crucial. Incorporate foods like grains, whole-grain products, fruits, vegetables, legumes, nuts, and seeds into your diet. These high-fiber options soften stools, making bowel movements easier and reducing strain on the fissures, which aids in healing and prevents further irritation.
How do you get anal fissures?
Anal fissures are typically caused by trauma to the anal canal, often from passing large or hard stools during constipation, chronic diarrhea, straining during bowel movements, or anal sex. In some cases, underlying conditions like Crohn’s disease may increase the risk of developing fissures.
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