Why is this happening to me?
I had hemorrhoid surgery about 2 years ago, in early 2021. I thought it was a dewormer because the anal itching was so severe, but when I took the dewormer, the symptoms didn't improve, so I went to the hospital and they said it was hemorrhoids. I was diagnosed with 3rd degree complex hemorrhoids, with both internal and external hemorrhoids.
It's been three years since I had hemorrhoid surgery and endured hellish times. I've always had mild fecal incontinence as a side effect of the surgery, and unlike others, I wasn't completely cured after the surgery, but I heard that fecal incontinence after hemorrhoid surgery can improve over time as the cushion tissue in the anus becomes hemorrhoidal again. I don't know much about that, but anyway, since the end of last year, which was my second year, the bleeding during bowel movements has stopped.
So I guess I forgot everything and let my guard down. About 3 months ago, I was too lazy to cook, so I lived on only digestive cookies for a week. I was excited about coffee and cookies. My intestines are so honest, and I ended up paying the price. After the hemorrhoid surgery, a lot of fat was removed, so my anus was already narrow, but when the stool became thicker and harder than usual, I couldn't stand it. It tore so badly that I experienced the pain right after the hemorrhoid surgery again.
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| The Betrayal of Whole Wheat Cookies |
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| I thought it had a lot of dietary fiber because it was whole wheat. |
From acute to chronic fissure
The anus refers to the end of the large intestine, the last 3~4cm. Just above the anus is the rectum, where stool collects, and the part that connects the rectum to the anus is called the anal canal. The anal canal is only 2.5~4cm long, but it has a complex structure and various interactions of muscles, nerves, and mucous membranes, and it plays a physiologically important role in protecting against organisms that can enter the body and distinguishing between solids, liquids, and gases to control defecation and gas discharge. The boundary dividing the upper 2/3 and lower 1/3 of the anal canal is called the pectinate line (or dentate line), and there is an anal gland near this that secretes slippery anal mucus to help stool pass smoothly. The anus usually refers to the area from the anal verge (the boundary between the anus and the surrounding skin) to the dentate line, and an anal fissure refers to the tearing or ulceration of the anal epithelium in this area.
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| Structure of the anus |
Constipation, diarrhea, increased tension in the internal anal sphincter, multiple childbirths, previous surgeries, etc. cause severe pain during defecation, and the pain continues for 1 to 2 hours after defecation, and may be accompanied by bleeding. In most cases, a triangular ulcer develops directly posterior to the anal opening (6 o'clock), and in about 19% of cases, it is located at the 12 o'clock position. An acute fissure looks like a laceration, and usually only the epidermis is torn, and it usually heals easily within 6 weeks as the epidermis regenerates. If it is not properly treated in the early stages, and the symptoms persist for more than 6 weeks due to repeated healing and worsening, it is called a chronic fissure. If it progresses to chronic, the pain does not become severe, and it is accompanied by a skin tag (pancreas) and hypertrophield anal papillae (known to be caused by irritation, damage, infection, etc.).
I've already passed the acute fissure stage, and since I'm still in pain, I think it's not chronic fissure, but rather imminent chronic fissure. Even though I endured the severe pain after the hemorrhoid surgery, I suffered from difficulty in defecation, bleeding, and fecal incontinence for two years, so I was afraid to go to the hospital, so I self-diagnosed it. I hope you all get an accurate diagnosis and treatment at the hospital... Personally, I think that the technology for hemorrhoid surgery has not developed enough. It's still developing, so I don't want to be a laboratory rat. Since I've already removed my only appendix with one surgery... Unless the fissure or symptoms are severe, surgery is not necessarily the solution. If you continue to feel uncomfortable and need management even after surgery, managing it well without surgery may not be the right answer, but it may be the best. So how should you manage it!?
Conservative treatment for chronic fissure
Acute fissure is cured by 60-90% through warm sitz baths, high-fiber diets, and local anesthetics or steroids (topical anesthetics or glucocorticoids), so conservative treatment is the principle. If it becomes chronic, the internal sphincter muscle becomes fibrotic, and its extensibility (ability to stretch) decreases even more, so even if the stool is not hard, it is easily torn and does not improve as easily as acute fissure. However, if there is no abscess or fistula in chronic fissure, it is better to try internal medicine treatment or conservative treatment first and then decide on surgery. Since surgical surgery for chronic fissure is a surgery to cut the fibrosed internal sphincter muscle, there is a risk of fecal incontinence after surgery in about 9.3% of cases. Of course, you can have surgery only after seeing a 90% cure rate, but I don't have enough money and the side effects of surgery are hit or miss, so I think it would be better to make a decision much more carefully than hemorrhoid excision surgery. Since I was in a state of chronic fissures with a glimmer of hope, I decided to try conservative treatment to see if it would heal naturally.
First of all, you all know that diet is the most important thing. I tried it and found that the main thing is important. Since I am a bread person, I thought that if I made sandwiches and ate them, I could eat them with a lot of vegetables, but the dietary fiber in green vegetables and the dietary fiber in grains are different. There is a big difference in the effects. First, I changed my main food from bread to rice. I mainly ate glutinous barley and glutinous brown rice, and mixed a little bit of oats and chickpeas, and ate side dishes mainly with mushrooms and green vegetables. I still haven't stopped eating bread and ramen, but I don't eat only bread all day. I know that if I do, I will definitely pay a price...
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| 100% glutinous barley rice with mushrooms |
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| A high-fiber diet is essential. |
And it is best to avoid foods containing caffeine, such as coffee and tea, as they have a diuretic effect and make your stool harder.
If you continue to have thin and loose stools during the period of tearing and healing, the wounds will be less severe and the pain will be less severe, but anal strictures may occur. Stools should be thick (important) and soft (important)...! I have always had constipation, but after hemorrhoid surgery, I realized for the first time in my life that I can have premium stools. You who are reading this article can also have premium stools...! 😭
It is also important to include exercise that stimulates the intestines, such as walking, in your diet to help with bowel movements. Even a light walk of about 30 minutes a day will be effective enough. It is good to do strength training as well, but avoid exercises that increase abdominal pressure, such as lifting heavy equipment, as they also increase anal pressure. Vigorous exercise that makes you sweat a lot is also not good because it makes the anus wet. For strength training, it seems like light home training at home on a yoga mat is appropriate.
The second is a warm sitz bath. It may seem obvious, but there are not many people who do sitz baths properly. I also went through trial and error. Even hospitals only tell you to do sitz baths, but they don’t teach you in detail. Hospitals make money by performing surgeries. So I studied on my own and learned by doing experiments on my own body.
First of all, I don’t use a sitz bath. A shower is enough. You have to soak your butt in a sitz bath, and a bidet is installed inside the toilet, so I don’t think it’s a very sanitary method. In the case of a bidet, the water flow is strong, so there are cases where the sensitive anus gets torn.
For a hot shower, use lukewarm water (40~42℃) with low water pressure for about 5 minutes. I think 2~3 times a day is appropriate. If you do it too often or for too long, it will get wet and not good. After a hot shower, be sure to dry it with a hair dryer. I thought gauze would absorb moisture, but using a hair dryer is much better. Since the anal area is not well ventilated, frequent sitz baths can easily cause fungal dermatitis. It is better to dry it with a cool air hair dryer.
The internal anal sphincter (IAS) accounts for 55% of the pressure of the anal canal at rest and plays a very important role in the excretion of liquid and gas, so if there is a problem with the IAS due to chronic fissures, it can often cause various uncomfortable symptoms such as incontinence of liquid stool or inability to hold back flatus, mucous rectal secretions flowing out, causing itching, burning, and inflammation in the anus.
I was more concerned about itching than pain, and judging from the color of the discharge on the gauze, it seems to be mucous discharge rather than fecal incontinence. In such cases, it is helpful to maintain cleanliness by taking a hot shower. When taking a hot shower, it is important to never rub, soap, or try to completely wash the inside of the anus. It may temporarily relieve the itching, but the more you touch the anus, the more it will itch and the condition will worsen. In particular, if you wash the inside of the anus excessively, the oil that lubricates the bowel movement will be washed away, which is not good, and the internal sphincter muscle will be stimulated, which can cause more mucous discharge. When washing the anus after a bowel movement, relax your fingers, slightly open the anus, and wash only with water, feeling that you are only washing away the contaminants on the outer folds of the anus. Soap can irritate damaged and sensitive skin with chemical ingredients such as surfactants, which can make itching worse, and this is the same with neutral soap such as Dove, so wash the anus only with water. Bacteria can be sufficiently washed away with water.
For mild itching, taking an antihistamine can help. Since it is an over-the-counter drug, you can buy it at a pharmacy without a prescription. Ask for a cheaper generic Zyrtec. I am currently taking one pill a day, and it seems to have the effect of reducing inflammation as well as itching.
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| Antihistamines may help. |
It may be a good idea to use suppositories or ointments to relieve itching and inflammation. Topical preparations containing hydrocortisone and ointments containing zinc oxide as the main ingredient can help relieve itching. If itching is due to fecal incontinence without any specific disease, applying a small amount of Vaseline to prevent direct contact between the skin and feces may also be a good idea. However, no matter what you apply, it seems right to use external preparations only under a doctor's diagnosis and prescription. If you use them incorrectly, the anus can become more wet and the chemical components can irritate it even more. The basic principles of conservative treatment for chronic fissures are cleanliness + dryness + non-irritating. If you need to apply something in addition, I recommend using it under an accurate diagnosis and only when absolutely necessary.
Then, I'll come back when I get some good information. Now, I hope all 650,000 people suffering from hemorrhoids in korea will do their best for the beautiful anus! 😭