Anal Fissures: Symptoms, Treatment, and When to See a Doctor

Anal fissure issues?

Hello doctor, I started experiencing issues with internal hemorrhoids in March of this year and consulted a doctor who mentioned that I also had a mild anal fissure.
At that time, the doctor only prescribed a stool softener.
My condition improved until May 18, when I experienced rectal bleeding again.
During bowel movements, there were blood streaks on the stool, blood in the toilet, and fresh blood on the toilet paper when wiping.
My stools were hard, and I have a habit of straining during bowel movements, which caused pain.
The next day, during bowel movements, there were only slight drops of blood, but the stool was much softer.
I thought the situation was improving, but today, during bowel movements, the stool was not hard, yet I noticed some blood on the stool and on the toilet paper, although it was better than a few days ago.
I have not seen a doctor during this period.
I would like to ask if my condition is indicative of an anal fissure or possibly colorectal cancer or rectal cancer.
If it is an anal fissure, do I need to see a doctor, or can I manage it by increasing my intake of fruits and vegetables? Will that cure it?

Miss Lin, 10~19 year old female. Ask Date: 2016/05/23

Dr. Ke Fangxu reply Surgery

Although the probability of developing colorectal cancer at the age of 18 is not zero, it is generally very low.
Based on your description, it seems more likely to be hemorrhoids combined with anal fissure bleeding.
It is recommended to maintain a light diet and a good lifestyle.
If symptoms persist without improvement, you may ask a physician for medication.
If there is still no improvement or if you are very concerned, a colonoscopy can be arranged.

Reply Date: 2016/05/23

More Info

Anal fissures are small tears in the lining of the anus, often caused by passing hard stools or straining during bowel movements. They can lead to symptoms such as sharp pain during and after bowel movements, bleeding, and discomfort. Given your description of experiencing blood on the toilet paper and in the toilet bowl, along with pain during bowel movements, it is indeed possible that you are dealing with an anal fissure.

The fact that you have a history of hemorrhoids and have experienced similar symptoms in the past suggests that your current issues may be related to the same underlying problems. Straining during bowel movements, which you mentioned as a habit, can exacerbate both hemorrhoids and anal fissures. When the stool is hard, it can cause trauma to the anal canal, leading to fissures.
In terms of treatment, there are several steps you can take to manage and potentially heal an anal fissure:
1. Dietary Changes: Increasing your intake of fiber-rich foods such as fruits, vegetables, and whole grains can help soften your stool, making it easier to pass. Staying well-hydrated by drinking plenty of water is also crucial.

2. Stool Softeners: Over-the-counter stool softeners can be beneficial in preventing hard stools and reducing the need to strain during bowel movements.

3. Warm Sitz Baths: Soaking in warm water for about 10-15 minutes several times a day, especially after bowel movements, can help soothe the area and promote healing.

4. Topical Treatments: There are topical medications available that can help relax the anal sphincter and promote healing. These may include nitroglycerin ointment or calcium channel blockers, which can be prescribed by a doctor.

5. Avoid Straining: It's important to avoid straining during bowel movements. If you feel the urge to go, try to respond promptly rather than holding it in.

Regarding your concerns about colorectal cancer, while anal fissures can cause bleeding, it is essential to note that bleeding can also be a symptom of more serious conditions, including colorectal cancer. Given your symptoms and the history of bleeding, it is advisable to consult a healthcare professional for a thorough evaluation. They may recommend a physical examination or further diagnostic tests, such as a colonoscopy, to rule out any serious conditions.

In summary, while it is possible that your symptoms are due to an anal fissure, it is crucial to seek medical advice to confirm the diagnosis and rule out any other potential issues. Early intervention can lead to better outcomes and prevent complications. If your symptoms persist or worsen, do not hesitate to see a doctor for further evaluation and treatment.

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