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Colorectal Diseases

Pain after anal rectal surgery.



Last year in December I had anal rectal surgery to remove an anal fistula. It took about one month for me to finally feel well enough without any pain. I remained pain free for about 5 weeks until one day I had a hard bowel movement and there was some bleeding. Proceeding that incident I began to have pain once again. I went back to my doctor and she treated the area with silver nitrate to stop the bleeding and I was told I tore the skin. It has been almost 2 months since I was treated for this problem but the pain is still there and I do not feel any better. I only feel better when I am off my feet and when I awake each morning. The pain usually occurs after I have my first bowel movement. I can feel this pain all along the area where the incision was made .....and mainly where the abcess exited. (Posterior and to the right) After several additional examinations, my doctor can not understand the reason for my pain. Everything looks healed and my doctor has done a colonoscopy on me as well as a sono to rule out any other underlining problems. All were negative. I have used niphedapine which healed the wound, I have been doing repeated sitz baths, watching my diet and eating enough fiber where my stools are soft. I am also on a trail run with taking 500 mg of tylenol 3 times daily for 2 weeks to help relax the muscles but I am almost at the end of the trial and the pain is still pretty uncomfortable. I have been told that the only other alternatives I have are to redo the surgery again to create a new scar or to have some chemical injected into the scar tissue to help break it up. These are two things I really do not want to do since I have been told that there will be no guarantee and the injection is experimental as well as poses some health risks. Why would I want to go thru a terrible surgery like that all over again with those odds? Is it possible for scar tissue in the anal area to create so much pain for this long?? Is there a possibility that the pain will gradually go away over time? Is there anything else less radical that I can consider? Please Help!!!!!!!!!


Sounds like you may have spasm of the anal sphincter, either due to a fissure or proctalgia fugax. Ask her to consider Botox in an effort to relieve your pain, if it would be safe and appropriate for you. Other possible therapies include pelvic floor physical therapy/rehab, myofascial massage, and seratonin reuptake inhibitors.

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Response by:

Janice Frederick Rafferty, MD Janice Frederick Rafferty, MD
Professor of Surgery
Chief of Colorectal Surgery Division
College of Medicine
University of Cincinnati