Anal Fissures: Symptoms, Treatment, and Pain Management

The issue of anal fissures?

Hello, Dr.
Ke.
I have been suffering from an anal fissure for a month.
In the first week, the condition was manageable, so I didn't pay much attention to it.
By the second week, the bleeding worsened, and I experienced dripping blood, but I was abroad and couldn't seek medical attention immediately.
I was also concerned about diarrhea and frequently took antacids, which I wonder if contributed to the worsening of the fissure.
It wasn't until the third week that I sought medical care and was diagnosed with an anal fissure.
The doctor prescribed a topical ointment called "Pezarol" and did not recommend sitz baths or any other precautions.
A week later, I underwent a colonoscopy, and a biopsy was taken from an inflamed area; I am still waiting for the report.
However, the ointment causes stinging pain and discharge when applied, and I found online that there are negative reports about this medication, so I purchased "Bona Hemorrhoid Cream" to use instead, but it hasn't been very effective.
I often experience pain at night that prevents me from sleeping.
I apply the medication by first using a cotton swab dipped in saline to clean the area, then directly applying the ointment to the wound.
Is this the correct approach? I also researched sitz baths online, but the relief is only temporary.
Should I take painkillers? The pain is so severe that I can't focus on my tasks.
I have been trying to maintain a diet rich in fruits and vegetables and drink plenty of water, but I can't distinguish whether the bleeding is from the anal fissure or the colon biopsy.

Lin, 20~29 year old female. Ask Date: 2016/05/18

Dr. Ke Fangxu reply Surgery

1.
This method of applying the medication is correct.
2.
If the pain remains severe after the sitz bath, taking pain relievers is acceptable.
3.
Since the location of the biopsy is unknown, it is not possible to determine whether the bleeding is from the biopsy site or if the anal fissure is still bleeding.
Anal fissures are inherently difficult to heal.
If there is significant bleeding, it is advisable to take hemostatic medications or consider surgical treatment.

Reply Date: 2016/05/18

More Info

Anal fissures are small tears in the lining of the anus, often resulting in significant pain and discomfort, especially during bowel movements. They can be caused by various factors, including constipation, diarrhea, and trauma to the anal area. In your case, it seems that the combination of dietary changes, potential gastrointestinal issues, and the use of certain medications may have contributed to the worsening of your condition.

Symptoms of Anal Fissures
The primary symptoms of anal fissures include:
- Sharp Pain: This is often described as a "cutting" pain during and after bowel movements.

- Bleeding: You may notice bright red blood on the toilet paper or in the toilet bowl.

- Itching or Irritation: The area around the fissure may feel itchy or irritated.

- Discomfort: You might experience discomfort while sitting or during physical activities.

Treatment Options
1. Topical Medications: You mentioned being prescribed a medication called "平痔隆" (likely a topical anesthetic or steroid). While these can help reduce inflammation and pain, they may not be effective for everyone. If you experience significant pain with this medication, it might be worth discussing alternatives with your doctor.

2. Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the area and promote healing. This is often recommended as a first-line treatment for anal fissures.

3. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements. Staying well-hydrated is also crucial.

4. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain. However, it's essential to follow the recommended dosages and consult with a healthcare provider if you have any underlying health conditions or are taking other medications.

5. Avoiding Irritants: If you suspect that certain medications (like antacids) may be contributing to your gastrointestinal issues, consider discussing this with your healthcare provider. They may recommend alternatives that are less likely to cause diarrhea or constipation.

Follow-Up Care
Since you have undergone a colonoscopy and are awaiting biopsy results, it’s crucial to keep your healthcare provider informed about any changes in your symptoms. If the pain persists or worsens, or if you experience new symptoms such as fever or severe bleeding, you should seek medical attention promptly.

Self-Care Tips
- Gentle Cleaning: After bowel movements, gently clean the area with warm water. Avoid using harsh soaps or wipes that may irritate the skin.

- Cotton Swabs: Using a cotton swab to apply medication can be helpful, but ensure that the area is clean before application. However, be cautious not to irritate the fissure further.

- Monitor Symptoms: Keep track of your symptoms, including any changes in pain levels, bleeding, or bowel habits, and report these to your doctor.

Conclusion
Anal fissures can be quite painful and may require a combination of treatments for effective management. It’s essential to maintain open communication with your healthcare provider regarding your symptoms and treatment efficacy. If your current regimen is not providing relief, do not hesitate to seek further evaluation or alternative treatments. Remember, healing takes time, and with the right approach, you can find relief from the discomfort associated with anal fissures.

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