Can Anal Fissures Be More Than Just Symptom Relief?

Can anal fissures only improve symptoms?

Hello, doctor! My current anal fissure is different from before; it was caused by diarrhea, and the fissure is internal with no external wounds.
Sitz baths and applying hemorrhoid ointment help relieve the pain, but if I only take sitz baths without the ointment, it still hurts.
I’ve read other people's responses, and it seems that this only alleviates the symptoms.
I'm not sure if continuing to apply the ointment and taking sitz baths will lead to improvement.
I have been using the ointment and taking sitz baths for over a week now; there is no bleeding, but I experience pain throughout the day, so I can only rely on the ointment for pain relief and frequent sitz baths.
I’m unsure how much longer the pain will last.
Will long-term use of the ointment cause skin atrophy or thinning? Thank you, doctor!

Zhen de hao tòng!, 40~49 year old female. Ask Date: 2016/04/21

Dr. Ke Fangxu reply Surgery

Anal fissures are a troublesome condition; although they are not life-threatening, they can be difficult to heal.
While they do not interfere with overall health, they can be quite uncomfortable.
Symptoms typically gradually diminish, but they usually persist for about a month.
The use of hemorrhoid ointments should not cause skin thinning, as they contain steroids at lower concentrations and strengths, so there is no need for excessive concern.

Reply Date: 2016/04/21

More Info

Anal fissures are a common condition that can cause significant discomfort and pain, especially during bowel movements. They are small tears in the lining of the anal canal, often resulting from trauma due to passing hard stools, diarrhea, or excessive straining. In your case, it seems that the fissure developed as a result of diarrhea, which can irritate the anal area and lead to fissures.

Symptom Relief and Treatment Options
The primary goal of treatment for anal fissures is to relieve symptoms and promote healing. Common conservative treatments include:
1. Sitz Baths: Soaking in warm water for 10-15 minutes several times a day, especially after bowel movements, can help soothe the area and promote blood flow, which is essential for healing.

2. Topical Medications: Over-the-counter creams or ointments, such as those containing hydrocortisone or lidocaine, can provide pain relief and reduce inflammation. However, prolonged use of topical steroids can lead to skin thinning, so it's important to use them judiciously and under the guidance of a healthcare provider.

3. Dietary Changes: Increasing fiber intake and hydration can help soften stools, making bowel movements easier and reducing the risk of further trauma to the anal canal. Foods rich in fiber include fruits, vegetables, whole grains, and legumes.

4. Stool Softeners: If dietary changes are insufficient, stool softeners can be used to facilitate easier bowel movements.

5. Avoiding Straining: It's crucial to avoid straining during bowel movements, as this can exacerbate the fissure and prolong healing.

Healing Process
While symptom relief is important, the ultimate goal is to allow the fissure to heal. Healing can take time, and it’s not uncommon for fissures to remain painful for several weeks, especially if they are not treated appropriately. If you have been using topical medications and sitz baths for over a week without significant improvement, it may be time to consult a healthcare provider for further evaluation.

When to Seek Further Treatment
If your symptoms persist despite conservative measures, or if you experience recurrent fissures, you may need to consider additional treatment options. These can include:
- Prescription Medications: Your doctor may prescribe stronger topical treatments, such as nitroglycerin ointment or calcium channel blockers, which can help relax the anal sphincter and promote healing.

- Botulinum Toxin Injections: In some cases, injections of botulinum toxin can be used to temporarily paralyze the anal sphincter muscle, reducing spasm and allowing the fissure to heal.

- Surgery: If conservative treatments fail, surgical options such as lateral internal sphincterotomy may be considered. This procedure involves cutting a small portion of the anal sphincter muscle to relieve tension and promote healing.

Conclusion
In summary, while topical medications and sitz baths can provide symptom relief for anal fissures, they are part of a broader treatment strategy aimed at promoting healing. It’s essential to monitor your symptoms and consult with a healthcare provider if you do not see improvement or if the pain persists. They can provide personalized recommendations and determine if further intervention is necessary. Remember, maintaining a healthy diet and avoiding straining during bowel movements are critical components of preventing future fissures.

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