Blood in Stool: Causes and Treatment for Anal Fissures

Blood in the stool?

I would like to ask the doctor about experiencing anal pain during bowel movements over the past few months (occurring approximately every two weeks).
Sometimes, there is a bit of blood on the toilet paper after wiping, and occasionally there are streaks of blood on the stool (but only a small amount).
I purchased an ointment for anal fissures from the pharmacy, and it has been effective.
What could be the cause of this? P.S.
I was diagnosed with an anal fissure in high school.

Niming, 20~29 year old female. Ask Date: 2016/04/30

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 causes of anal fissures are often due to hard stools, but 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 advisable to consult a physician for further evaluation.

Reply Date: 2016/04/30

More Info

Understanding blood in stool, particularly in the context of anal fissures, is crucial for both diagnosis and treatment. Based on your description, it seems that you are experiencing symptoms consistent with anal fissures, which are small tears in the lining of the anus. These can cause pain during bowel movements and may lead to the presence of blood on toilet paper or on the stool itself.

Causes of Anal Fissures
Anal fissures can occur for several reasons, including:
1. Constipation and Straining: Hard stools can stretch the anal canal, leading to tears. If you are experiencing constipation, this could be a significant factor.

2. Diarrhea: Frequent loose stools can also irritate the anal area, contributing to fissures.

3. Childbirth: For women, the trauma of childbirth can lead to fissures.

4. Anal Intercourse: This can also cause trauma to the anal region.

5. Underlying Conditions: Conditions such as Crohn's disease or other inflammatory bowel diseases can increase the risk of developing fissures.

Symptoms
The symptoms you described—pain during bowel movements, occasional blood on toilet paper, and blood streaks on stools—are typical of anal fissures. The pain can be sharp and may last for several minutes after a bowel movement. The presence of blood is usually bright red, indicating that it is fresh and likely coming from the anal area rather than higher up in the gastrointestinal tract.

Treatment Options
1. Topical Treatments: As you mentioned, you have been using a topical ointment for anal fissures. These ointments often contain ingredients like nitroglycerin or calcium channel blockers, which help to relax the anal sphincter and promote healing.

2. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also essential.

3. Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the area and promote healing.

4. Avoiding Straining: It's important to avoid straining during bowel movements. If you are constipated, consider using stool softeners or laxatives as recommended by your healthcare provider.

5. Medical Intervention: If conservative measures fail, a healthcare provider may recommend further treatments, such as Botox injections to relax the anal sphincter or surgical options for chronic fissures.

When to Seek Medical Attention
If your symptoms persist despite treatment, or if you experience significant bleeding, severe pain, or signs of infection (such as fever or pus), it is important to consult a healthcare professional. They may perform a physical examination and possibly recommend further diagnostic tests to rule out other conditions.

Conclusion
In summary, your symptoms are likely related to anal fissures, which can be effectively managed with a combination of topical treatments, dietary modifications, and good bowel habits. Since you have a history of anal fissures, it is essential to monitor your symptoms and seek medical advice if they worsen or do not improve with home treatment. Regular follow-ups with a healthcare provider can help manage and prevent recurrence of this condition.

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