Q. Patient has excreting problem. Is it a fissure and does it need surgery?

Answered by
Dr. Noushif M
and medically reviewed by iCliniq medical review team.
Published on Apr 01, 2018

Hello doctor,

My brother is 38 years old and he is obese. His weight is more than 150 kg. He has been found with liver cirrhosis few years back and he has taken medicine for that and all went normally. Later, he found with balanitis but after medicine he was normal. At present, he used to drink but now he is facing an issue. He has an issue with excreting out due to a fissure. He said that a few days back when he was in the washroom, he felt some piece of flesh came out through his excretory part and he used to have tight stools and feels some pricking type in his anus. His tummy also feels like some balloon on his left side of tummy. He is asking that whether he is facing fissure issue and should get this thing operated or not. Sir, I want to know what should we do. He is a hypertensive too.

Dr. Noushif M

General Surgery Medical Gastroenterology Surgical Gastroenterology


Welcome to icliniq.com.

I could find three issues with your brother. They are obesity, cirrhosis, and fissure. All these are related. He needs to lose weight. He has to be motivated with regular physical activity, modified diet and restrict fluid to 2 liters a day. Regarding cirrhosis, he needs to be on regular follow up. We need to check how bad his liver is. We need to check his :

  1. Blood count.
  2. Liver function test.
  3. Creatinine.
  4. INR (international normalized ratio).
  5. USG (ultrasonography) abdomen.

Being cirrhotic he needs to have two to three times of bowel movements daily that too soft stools. When stools become hard, his fissures (cracks) in the anal region become worse and painful. So, the first step is to avoid constipation and constipating foods. Take syrup Looz (Lactulose) 30 ml at night or twice or thrice daily to achieve adequate soft stools. You can use these two creams alternately every four hours for acute pain, Cremagel (Diltiazem) and Smuth (Lidocaine, Dobisilate, and Hydrocortisone) cream. Better to try without surgery as he is cirrhotic. If pain does not settle with these measures you can go ahead with surgery. Definitely, he has to be abstinent from all liver-damaging substances.

For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist

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