Managing Rectal Bleeding: Tips for Dealing with Anal Fissures

Blood in stool

Doctor, I recently visited for rectal bleeding and was diagnosed with an anal fissure.
After taking medication and using suppositories for a while, I felt some improvement.
However, after stopping the medication for just a few days, I started experiencing pain during bowel movements again.
I resumed using suppositories, but I'm still experiencing bleeding.
How should I handle this situation?

Lin, 20~29 year old female. Ask Date: 2016/03/30

Dr. Ke Fangxu reply Surgery

This situation is likely indicative of hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on bowel movements.
Warm sitz baths may also help alleviate symptoms.
You can purchase hemorrhoid suppositories at the pharmacy for use.
It is best not to take stool softeners indiscriminately; at this age, increasing dietary fiber and fluid intake should be sufficient.
If bleeding persists, it is advisable to consult a physician for evaluation.

Reply Date: 2016/03/30

More Info

Managing rectal bleeding, particularly due to anal fissures, can be a challenging and uncomfortable experience. Anal fissures are small tears in the lining of the anus, often caused by passing hard stools, which can lead to pain and bleeding during bowel movements. Here are some tips and recommendations for managing this condition effectively.

1. Dietary Modifications
One of the most important aspects of managing anal fissures is to ensure that your stool remains soft and easy to pass. This can be achieved through dietary changes:
- Increase Fiber Intake: Incorporate more fruits, vegetables, whole grains, and legumes into your diet. Aim for at least 25-30 grams of fiber per day.

- Stay Hydrated: Drink plenty of water throughout the day. Adequate hydration helps soften stool and prevent constipation.

- Consider Fiber Supplements: If you're struggling to get enough fiber from food, consider using a fiber supplement like psyllium husk or methylcellulose.

2. Regular Bowel Habits
Establishing a routine for bowel movements can help reduce strain:
- Don’t Hold It In: Respond to the urge to have a bowel movement promptly to avoid hardening of stool.

- Avoid Straining: Straining can worsen fissures. If you find yourself straining, consider using a stool softener or laxative as recommended by your healthcare provider.

3. Topical Treatments
You mentioned using medications and suppositories, which can be beneficial:
- Topical Nitrates: These can help relax the anal sphincter and increase blood flow to the area, promoting healing.

- Calcium Channel Blockers: Topical medications like diltiazem or nifedipine can also be effective in reducing anal sphincter pressure.

- Hydrocortisone Cream: This can help reduce inflammation and discomfort.

4. Sitz Baths
Taking warm sitz baths can provide relief:
- How to Do It: Sit in a few inches of warm water for about 15-20 minutes, several times a day, especially after bowel movements. This can help soothe the area and promote healing.

5. Pain Management
If you're experiencing significant pain:
- Over-the-Counter Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation.

- Avoid Irritants: Be cautious with soaps and wipes that may irritate the anal area. Opt for gentle, unscented products.

6. Follow-Up with Your Healthcare Provider
Since you have experienced recurrent bleeding and pain:
- Reevaluation: It’s essential to follow up with your healthcare provider to reassess your condition. They may consider additional treatments, such as botulinum toxin injections to relax the sphincter or, in severe cases, surgical options like lateral internal sphincterotomy.

7. Preventing Recurrence
To prevent future fissures:
- Maintain Healthy Bowel Habits: Continue with dietary changes and hydration.

- Regular Exercise: Physical activity can help promote regular bowel movements.

Conclusion
Managing anal fissures requires a multifaceted approach that includes dietary changes, proper bowel habits, topical treatments, and regular follow-ups with your healthcare provider. If your symptoms persist or worsen, it’s crucial to seek medical advice to explore further treatment options. Remember, while anal fissures can be painful and distressing, they are often manageable with the right strategies and care.

Similar Q&A

Effective Treatments and Medications for Anal Fissures: A Guide

Hello, doctor. Recently, I have been experiencing bleeding during bowel movements, possibly due to increased stress. What treatment options are available, and what medications should I apply? Thank you for your guidance.

Dr. Hou Yongji reply Surgery
1. If there is rectal bleeding, it is essential to be examined by a specialist. Do not assume it is hemorrhoids or anal fissures and treat it casually. 2. In young individuals, rectal bleeding is often due to anal fissures, most of which will heal naturally. Treatment should foc...

Managing Anal Fissures: Tips for Relief from Pain and Bleeding

Hello Doctor, I have recently experienced anal fissures due to constipation (which means I have severe pain and even bleeding during bowel movements). I have been drinking plenty of water and eating a lot of fruits and vegetables, but the situation doesn't seem to improve. E...

Dr. Lin Minghui reply Gastroenterology and Hepatology
Hello: In addition to dietary considerations (such as increasing water intake and fiber consumption), it is recommended to have a colorectal surgeon confirm the diagnosis. There are local or oral medications that can alleviate pain and promote healing. If there is an anal fissure...

Managing Chronic Anal Fissures: Effective Treatments Beyond Surgery

Hello Dr. Ke, About two months ago, I experienced rectal bleeding during a bowel movement (there was blood on the stool and also on the toilet paper). After that, for about a week, the surface of the stool was stained with blood, and I felt pain when passing stool. When I insert...

Dr. Ke Fangxu reply Surgery
Chronic anal fissure is a troublesome condition that, while not severe, often does not respond well to conservative treatment. The only relatively effective option is surgery. If you prefer to avoid surgery, your current approach is sufficient, and you can additionally use topica...

Managing Painful Hemorrhoids: Effective Treatments and Relief Strategies

I have been experiencing diarrhea for the past 2-3 days, and it hurts when I wipe after using the bathroom. I noticed that there is a lot of blood on the toilet paper. Last night, when I got up to use the bathroom, there was also a large amount of blood (including blood clots), a...

Dr. Ke Fangxu reply Surgery
Based on your description, it seems to be an anal fissure. The typical symptoms include pain during bowel movements accompanied by slight bleeding. If there is concurrent bleeding from hemorrhoids, the amount of blood may be more significant. The primary cause of anal fissures is...