Hello,

Thank you for approaching Doctotspring.com to clear your doubt. Usually people hesitate to visit a doctor for anal fissures or hemorrhoids. Good that you approached your doctor to find out the diagnosis. Anal fissures are longitudinal tear in the lower end of anal canal. It is commonly seen in young patients of your age. I guess you would have been suffering from constipation, severe pain during and after defecation and there might even be streak of fresh blood or drop of bleed in your hard stools. These are the usual symptoms of anal fissures. I guess your doctor would have confirmed your diagnosis by inspecting the sentinel pile, which is a tag of skin at the lower end of the fissure, which is evident in the picture you have sent, and also by appreciating the sphincter spasm from the rectal examination.

Most of the anal fissures are initially managed conservatively and the emphasis must be placed on normalization of bowel habits such that passage of stool is less traumatic.

· Fiber is important to your diet to avoid becoming constipated or passing hard stools. Eat plenty of fruits and vegetables. Avoid sitting on the toilet for long periods, and use a small footstool to prop your feet on if you find passing stool uncomfortable. This way of sitting sometimes helps to decrease pressure and discomfort during a bowel movement. Minimize your intake of junk foods and meats, as they are hard to digest. Avoid processed food.

· You should ensure that you drink 6-8 glasses of water throughout the day. Water is your best friend because it helps increase your bowel movement and prevents constipation, which is one of the causes of rectal bleeding

· You can do sitz bath (it is a small plastic basin that you fill water and sit on it to submerge your rectal area on it)

· Topical local anesthetic agents like lignocaine jelly can be used to relieve the pain.

· Glyceryl trinitrate 0.2% topical application can reduce sphincter spasm to a great extend.

Follow the above measures. If it fails to cure your anal fissure, then you can opt for surgery consisting of lateral internal sphincterotomy or anal advancement flap. Usually 80% of people are cured conservatively so there is nothing to be worried about.

Hope this helps, please feel free to discuss further.
Thank you.

Hello,
Thank you for your follow up question.

Differential diagnosis for warts possibly be skin tags, sentinel pile, condyloma lata which is a manifestations of secondary syphilis, anal polyps, anorectal abscess, squamous cell carcinoma. From the picture you have sent it appears to be anal fissure. There is evidence of sentinel pile. But anyways you have to undergo rectal examination( includes inspection and palpation of the affected area) to confirm the diagnosis. There is no drugs as such to heal the fissure. It spontaneously heals by itself.

You can use lignocaine jelly for pain and glyceryl trinitrate 0.2% topical application to reduce sphincter spasm. It takes time to heal and your constipation can aggravate the fissure and prevent it from healing. So your main goal should be to prevent your constipation by conservative management by following the previous mentioned measures. If the conservative management fails, i suggest you to opt for surgery.

Thank you.

Hello,

These appears to be associated (possible) infected pustules. Your Doctor might have prescribed some antibiotic for you. This should take care of these lesions.

Thank you