chronic anal fissure and constipation

[adarsh]

Sir,

I have been taking hypertensive medication (Tenormin 50) for the last 10 yrs. I never had a good bowel movement continuously since my child hood. Some days it would be very good and most of the days it was quite straining and hard stools. I remember in the year 1994, I had blood while defacation after straining too much for hard stools. I did not approach any doctor as my dad was having anal piles (hemorrage) from long time so I thought it is heredictary. After some time, the problem got vanished. The same thing repeated in 2003 very seriously with blood in stool and pain and the doctor detected anal fissure. I took laxatives and then it became okay. When I stopped laxatives, it started hard stools and pain while defecation with some times blood. That episodes were quite in and out some times hard stools and some times soft stools. From the last couple of years, I have been taking "slimming tea" by dipping a packet of 0.8 g cassia leaves and 0.8 g cassia roots in hot water and drinking the cold tea. I never had any problem of hard stool but whenever I stop the slimming tea, I start getting hard stool. I am taking plenty of water and a lot of fruits and vegetables. Recently, I read in some of the magazines that constiption, blood in the stool etc, are the symptoms of colorectal cancer. I am afraid..is this really cancer? How to stop laxatives? I did not have any notable stomach pain so far.

[Dr. Safaa Mahmoud]

Hello,
Your history is very suggestive of piles and anal fissure. However, direct clinical examination is essential to exclude any other causes.

You have a long history of recurrent blood in stools or bleeding per rectum which is associated with hard stools and constipation. The condition recovers after regulating your bowel habits and avoiding constipation and staring. These characters are less likely to be seen with malignancy. Cancer is a progressive process and rarely if never resolves alone or by conservative measures. Colon cancer usually presents with bowel habit changes (symptoms of new onset) and bleeding per rectum.

However, even if you have genetic susceptibility and it is common to have piles and anal fissure in your family, direct medical consultation and follow up with your doctor are essential to avoid complications.

Only by direct clinical examination and investigations the correct diagnosis can be reached. I would advise you to follow up with your doctor.

Please keep us updated.
Best regards.