Anal Fissures: Pain Management and Treatment Options

Anal fissure pain

Last Friday, I visited the municipal hospital for a consultation with the doctor.
After the examination, the doctor prescribed rectal suppositories and ointments.
After using the medications, my symptoms improved (I used the suppositories for three days), but after one or two days of improvement, I started to feel a burning sensation in the anus during bowel movements, and it seems like the symptoms are about to recur.
Is this a psychological effect? Or is it because I haven't used the suppositories? Or could it be due to other reasons (like using too much ointment)?...
(When I take a sitz bath, I do touch the area around the anus; could this be irritating the wound?) (My stools are still relatively soft, but I have bowel movements two to three times a day.) Should I schedule another appointment?

Peipei, 10~19 year old female. Ask Date: 2016/06/27

Dr. Ke Fangxu reply Surgery

If the duration of bowel movements is prolonged, a burning sensation at the anal opening is inevitable.
It is recommended that you continue using topical medications along with sitz baths, and there is no need for a follow-up appointment.
Avoid stimulating the anal area with your hands, and maintain cleanliness.

Reply Date: 2016/06/27

More Info

Anal fissures are small tears in the lining of the anal canal, often causing significant pain and discomfort, especially during bowel movements. They can be quite distressing, and managing the symptoms effectively is crucial for recovery. Based on your description, it seems you have been following a treatment plan that includes the use of topical medications such as suppositories and ointments, which is a common approach for managing anal fissures.

The initial improvement you experienced after using the suppositories is a positive sign, indicating that the treatment may have been effective in reducing inflammation and promoting healing. However, the recurrence of symptoms, such as a burning sensation during bowel movements, can be attributed to several factors:
1. Incomplete Healing: Anal fissures can take time to heal completely. Even if you notice improvement, the fissure may not be fully healed, and certain activities or bowel movements can irritate the area, leading to a resurgence of pain.

2. Bowel Habits: You mentioned that you have soft stools and are having bowel movements two to three times a day. While soft stools are generally beneficial for healing, frequent bowel movements can lead to irritation of the anal area. It’s important to maintain a balance and avoid straining during bowel movements, as this can exacerbate the fissure.

3. Topical Medication Use: Overuse of topical medications can sometimes lead to irritation rather than relief. If you are applying ointments or suppositories too frequently, it might cause additional discomfort. It’s essential to follow the prescribed dosage and frequency.

4. Physical Irritation: You mentioned that you sometimes touch the area during sitz baths. While maintaining hygiene is important, excessive manipulation of the area can irritate the fissure and delay healing. It’s advisable to be gentle and avoid any unnecessary touching.

5. Psychological Factors: Anxiety about the pain can sometimes amplify the perception of discomfort. If you are worried about the fissure, it may heighten your sensitivity to pain during bowel movements.

Given your situation, it would be wise to consider the following steps:
- Continue with the prescribed treatment: Stick to the regimen recommended by your doctor, including the use of suppositories and ointments, but be mindful of the frequency and amount you apply.

- Monitor your bowel habits: Aim for regular, soft bowel movements without straining. You might consider dietary adjustments, such as increasing fiber intake and staying hydrated, to help maintain stool consistency.

- Avoid irritation: Limit any physical manipulation of the area. During sitz baths, focus on relaxation rather than probing the area.

- Follow up with your doctor: If symptoms persist or worsen, it’s advisable to return to your healthcare provider. They may want to reassess the fissure, consider alternative treatments, or evaluate for other underlying issues that could be contributing to your discomfort.

In conclusion, while some recurrence of symptoms can be normal during the healing process of an anal fissure, persistent pain or burning sensations warrant further evaluation. Your healthcare provider can offer guidance tailored to your specific situation and help ensure that you are on the right path to recovery.

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