Anal Fissures: Causes, Symptoms, and Treatment Options

Anal fissure pain

I have been experiencing anal pain after bowel movements for almost a month.
I consulted a doctor who diagnosed it as an anal fissure.
I have been using topical medications and taking sitz baths, but the pain comes and goes.
I had a period where the pain was less severe, so I stopped the medication for a while, fearing dependence on it.
I also rode my bike, but the saddle was hard, and shortly after, the pain returned.
I have bowel movements twice a day; my stools are neither soft nor hard, and I eat a lot of vegetables.
Could this be the reason for my recurring symptoms? What are the possible causes of anal fissures?

Pei Pei, 10~19 year old female. Ask Date: 2016/07/22

Dr. Ke Fangxu reply Surgery

The typical symptoms of anal fissures include pain during bowel movements accompanied by slight bleeding.
If there is concurrent bleeding from hemorrhoids, the amount of blood may be greater.
The primary cause of anal fissures is usually hard stools; however, diarrhea, frequent bowel movements, or prolonged straining can also lead to fissures.
In young individuals experiencing recurrent anal fissures, it is often related to their lifestyle and bowel habits.
It is recommended to improve bowel habits and to take warm sitz baths to alleviate symptoms.
If you are using topical ointments and suppositories for treatment and are experiencing good results, it is advisable to continue using them.
Do not discontinue the medication prematurely before the treatment effects are fully realized, as these medications are not controlled substances and do not pose a risk of dependency.

Reply Date: 2016/07/22

More Info

Anal fissures are small tears in the lining of the anus, which can cause significant pain and discomfort, particularly during and after bowel movements. Understanding the causes, symptoms, and treatment options for anal fissures is essential for effective management and relief.

Causes of Anal Fissures
1. Trauma to the Anal Canal: The most common cause of anal fissures is trauma, which can occur during bowel movements, especially if the stool is hard or large. Even if your stool is not hard, straining during bowel movements can lead to fissures.

2. Chronic Constipation or Diarrhea: Both conditions can contribute to the development of anal fissures. In cases of constipation, straining to pass hard stools can cause tears. Conversely, frequent loose stools can irritate the anal area.

3. Childbirth: Women may experience anal fissures during childbirth due to the pressure exerted during delivery.

4. Anal Intercourse: This can also lead to trauma and subsequent fissures.

5. Underlying Health Conditions: Conditions such as inflammatory bowel disease (IBD), Crohn's disease, or other gastrointestinal disorders can increase the risk of developing anal fissures.

6. Poor Blood Flow: In some cases, reduced blood flow to the area can impair healing and contribute to the persistence of fissures.

Symptoms of Anal Fissures
The primary symptom of an anal fissure is pain during and after bowel movements. Other symptoms may include:
- Bleeding: You may notice bright red blood on the toilet paper or in the toilet bowl after a bowel movement.

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

- Visible Tear: In some cases, a fissure may be visible as a small tear in the skin around the anus.

Treatment Options
1. Topical Treatments: Your doctor may recommend topical anesthetics or medications to help relieve pain and promote healing. These can include creams or ointments that contain nitroglycerin or calcium channel blockers, which help relax the anal sphincter and increase blood flow to the area.

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

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. Stool Softeners: Over-the-counter stool softeners can help make bowel movements easier and less painful.

5. Avoiding Strain: It’s essential to avoid straining during bowel movements. If you feel the urge to go, try to respond promptly rather than delaying.

6. Medications: If conservative treatments fail, your doctor may consider other options, including botulinum toxin injections to relax the anal sphincter or, in severe cases, surgical options to remove the fissure.

Conclusion
Given your situation, it seems that the pain may be exacerbated by factors such as the hardness of your bicycle seat and possibly the consistency of your stools. While you are consuming a lot of vegetables, it’s important to ensure that you are also drinking enough water to help keep your stools soft. If the pain persists or worsens, it’s crucial to follow up with your healthcare provider for further evaluation and management. They may recommend additional treatments or adjustments to your current regimen to help alleviate your symptoms effectively.

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