Anal Fissures: Causes, Treatments, and Recovery Tips

Anal fissure issues?

Hello, Dr.
Ke! Mid-month, I experienced diarrhea that caused a fissure on the right side internally.
I have been doing sitz baths and applying medication, and it has gradually improved.
Recently, my mother heard someone mention a traditional Chinese medicine remedy and urged me to try it.
I only took it twice, but the next day I had diarrhea again, and now the pain has moved to the back, although there is no bleeding.
The pain on the right side seems to have subsided, but this time it doesn't feel like the sharp pain I had before; instead, it is a dull, persistent ache that lasts a long time.
The topical medication doesn't seem to relieve the pain much, and when I don't apply it, the pain is less intense, so I told my mother that I can't take that herbal remedy anymore!
I researched some information and found that most fissures occur in the front and back positions.
Last time, I had a hemorrhoid on the right side that was banded, and after a week of severe diarrhea for three to four days, it caused a fissure.
This time, I only had diarrhea for half a day before it stopped, but the next day I experienced significant pain in the back.
Regardless of which side, I always rinse with water after using the restroom and take sitz baths several times a day.
I am concerned that if there is a fissure inside, I can only clean the outside after using the restroom.
Even with sitz baths, I can't completely clean the inside, so if there are remnants of stool, won't that lead to an infection of the wound? When I visit the doctor for an anoscopy, there are always some remnants present, and the doctor and nurse have to clean it off before examining me, which makes me feel quite embarrassed.
Now that the fissure is in the back, will it take longer to heal compared to the previous fissure on the right side? Since applying the medication is painful, will it heal if I only continue with sitz baths without applying the medication? I have never had issues on the left side; it has always been on the right whenever I have diarrhea.
This is the first time I have experienced pain in the back, and previously, it was mostly external around the anal area.
This is my first experience with internal issues, and I wonder if it will fissure again after healing, either because the previous fissure didn't heal completely or due to some difficult-to-heal scar tissue inside (since I can't see or feel inside and I'm afraid to insert anything into the anus).
Currently, I maintain a regular diet with three meals a day, eat more fruits and vegetables, and drink plenty of water.
I usually eat fish and chicken, but I eat other meats less frequently.
My bowel movements are soft, and I used to have three bowel movements a day, but now I am trying to adjust to two times a day to avoid affecting the wound, along with more sitz baths.
Besides that, it seems there are no better methods available? In addition to the ointment, I also have a suppository.
I used it for a few days at the beginning, but one night while using it, I felt significant pain passing over the wound, so I haven't used it much since.
Thank you, doctor!

You again, so painful!, 40~49 year old female. Ask Date: 2016/04/27

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.
The primary cause of anal fissures is usually hard stools; however, diarrhea, frequent bowel movements, or prolonged straining can also lead to fissures.
It is recommended to improve bowel habits and to take warm sitz baths to alleviate symptoms.
Topical ointments and suppositories can also be used for treatment.
If symptoms persist for more than a week without improvement, it is important to consult a physician to identify the underlying issue.
It is normal to have residual stool in the rectum, but if the amount is significant, a stool softener may be needed to help clear it out.
Anal fissures typically have prolonged symptoms, but as long as there is continuous improvement, it is not a concern.
Sitz baths are generally recommended at least 3-4 times a day.
If symptoms do not improve, surgical intervention may be the only option left.

Reply Date: 2016/04/27

More Info

Anal fissures are small tears in the lining of the anus, often caused by trauma during bowel movements, particularly when passing hard stools or experiencing diarrhea. Your situation, where you experienced diarrhea leading to a fissure, is quite common. The pain you describe, especially the sharp pain that feels like a "jumping" sensation, is typical of anal fissures, particularly when they are acute.

Causes of Anal Fissures
The primary causes of anal fissures include:
1. Trauma: This can occur from passing hard stools, prolonged diarrhea, or even from anal intercourse.

2. Inflammation: Conditions such as inflammatory bowel disease (IBD) can lead to fissures.

3. Increased Pressure: Conditions that increase pressure in the anal area, such as constipation or straining during bowel movements, can contribute to fissure formation.

Treatment Options
1. Sitz Baths: As you are already doing, sitz baths can help soothe the area and promote healing. Soaking in warm water for about 10-15 minutes several times a day can help relax the anal sphincter and improve blood flow to the area.

2. Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone or other soothing agents can help reduce inflammation and pain. However, if you find that a particular ointment is causing more pain, it may be best to discontinue its use.

3. Dietary Adjustments: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools, making bowel movements easier and less painful. Staying hydrated by drinking plenty of water is also crucial.

4. Laxatives: If dietary changes are not sufficient, a gentle laxative may be recommended to prevent constipation and reduce straining during bowel movements.

5. Medications: In some cases, a doctor may prescribe topical nitroglycerin or calcium channel blockers to help relax the anal sphincter and promote healing.

6. Avoiding Irritants: Be cautious with any home remedies, especially those involving herbal or traditional medicines, as they can sometimes exacerbate the issue. It's good that you stopped taking the herbal remedy that seemed to worsen your symptoms.

Recovery Tips
- Hygiene: Maintaining good hygiene is essential. After bowel movements, gently clean the area with water and avoid using harsh soaps or wipes that can irritate the skin.

- Avoid Straining: Try to avoid straining during bowel movements. If you feel the urge to go, don’t delay it, as this can lead to harder stools.

- Monitor Symptoms: Keep an eye on your symptoms. If the pain persists or worsens, or if you notice any signs of infection (such as increased redness, swelling, or discharge), it’s important to consult a healthcare provider.

Healing Time
The healing time for anal fissures can vary. Acute fissures may heal within a few weeks with proper care, while chronic fissures can take longer, especially if there is ongoing irritation or if they are not treated effectively. If you find that the pain persists or if you have recurrent fissures, it may be worth discussing further treatment options with your healthcare provider, which could include more advanced interventions.

Conclusion
It sounds like you are taking the right steps to manage your condition. Continue with your sitz baths, maintain a high-fiber diet, and stay hydrated. If you have any concerns about the healing process or if your symptoms do not improve, don’t hesitate to reach out to your healthcare provider for further evaluation and management. Remember, healing can take time, and being patient with your body is key.

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