Hello doctor, Four years back, I got constipation for two days and due to that I had some mass near my anal opening, but it does not cause any pain or bleeding while defecation. Doctor told it is a sentinel and no treatment is required. Now two years back I had an anal fissure. It got healed but reappear after every two or three months. I also follow my diet regime and water intake but still, it reappears mildly with mild pain. Will it ever be treated by medicines or I need surgery? Currently, I am not taking any medicines. Please suggest.
Hi. The sentinel pile mass you have is due to an underlying chronic fissure. The issues with fissure are usually aggravated by constipation. The main factor to avoid fissure is to avoid constipation or hard stools or even straining at stools. When you have a chronic fissure you have to follow these measures. 1. Dietary precautions, avoid constipating foods. 2. Good hydration, drink two to three liters of water. 3. Use laxatives like lactulose syrup as and when needed to avoid constipation. These can be used at night so as to have a good bowel movement in the morning. 4. Anal creams containing Lignocaine (Smuth, Anovate, etc) or Diltiazem (Diltigesic) when you have pain. Surgery is done only when you have acute fissure with severe intolerable pain. Not preferred in chronic fissure as is your condition. Pain occurs due to spasm of the sphincter muscle and surgery aims at its division partly. It will be effective only when it is acute. You can now continue your dietary measures, laxatives, and anal cream as and when needed. I hope this helps.