Chronic Anal Fissure: When to Seek Medical Attention?

Chronic anal fissure?

Hello Doctor, three months ago I experienced pain during bowel movements and was diagnosed with an acute anal fissure.
I have had occasional rectal bleeding in the past, which I thought was due to hemorrhoids, but it would resolve after a while and then recur.
The outpatient doctor advised me to increase my fiber intake and take warm sitz baths for two to three months, so I was not prescribed any medication.
I have been exercising and controlling my diet, with bowel movements occurring about once every 1 to 2 days, and they are generally soft.
However, I rarely perform sitz baths.
I do not feel discomfort in my daily life, but I experience pain whenever a stool passes through the anus.
The pain increases with the hardness of the stool, but it subsides once the stool has passed.
Each time, there is either blood on the toilet paper or in the toilet bowl.
My workplace provides sashimi as employee meals, and I wonder if that could be related.
Doctor, do I need to return for a follow-up appointment, or should I wait a few months to see if there is any improvement? Thank you, Doctor! (Diet: boiled chicken, broccoli, carrots, shredded cabbage, fish, whole grain rice, sweet potatoes)

Yang, 20~29 year old female. Ask Date: 2016/08/08

Dr. Ke Fangxu reply Surgery

The troublesome aspect of anal fissures is that they are difficult to heal.
The symptoms may not be severe, but complete recovery is often elusive.
It is not necessarily related to your occupation.
If the condition significantly impacts your daily life, surgical treatment may be the most effective option for improvement.

Reply Date: 2016/08/08

More Info

Chronic anal fissures can be a painful and distressing condition, often leading to significant discomfort during bowel movements. Based on your description, it appears that you have been experiencing recurrent pain and bleeding during defecation for the past three months, which is consistent with a chronic anal fissure. While your initial treatment advice included dietary modifications and warm sitz baths, it is essential to consider when to seek further medical attention.

When to Seek Medical Attention
1. Persistent Symptoms: If you continue to experience pain during bowel movements, especially if it worsens or does not improve with conservative measures, it is advisable to return to your healthcare provider. Chronic fissures can become more complicated if not treated adequately.

2. Bleeding: The presence of blood on toilet paper or in the toilet bowl, as you described, is a sign that the fissure may not be healing properly. While some bleeding can be expected with fissures, persistent or increasing bleeding warrants further evaluation.

3. Infection Signs: If you notice any signs of infection, such as increased redness, swelling, or discharge from the fissure site, you should seek medical attention promptly. Infections can complicate the healing process and may require additional treatment.

4. Impact on Quality of Life: If the pain is affecting your daily activities, work, or mental well-being, it is crucial to discuss this with your doctor. Chronic pain can lead to anxiety and depression, and addressing the fissure may improve your overall quality of life.

5. Failure of Conservative Treatment: If dietary changes, sitz baths, and other conservative measures do not lead to improvement within a few weeks, it may be time to consider other treatment options. These can include topical medications, such as nitroglycerin ointment or calcium channel blockers, which can help relax the anal sphincter and promote healing.

Additional Considerations
- Dietary Factors: While you mentioned a healthy diet, it is essential to ensure you are consuming enough fiber and staying well-hydrated. Fiber supplements may also be beneficial if you find it challenging to get enough fiber from food alone. The goal is to maintain soft, well-formed stools to minimize trauma to the anal area during bowel movements.

- Sitz Baths: Regular warm sitz baths can help soothe the area and promote healing. Aim for at least two to three sitz baths per day, especially after bowel movements.

- Avoiding Irritants: If you suspect that certain foods, such as raw fish, may be contributing to your symptoms, consider discussing dietary adjustments with a nutritionist or your healthcare provider.

- Follow-Up Care: Regular follow-up with your healthcare provider is essential, especially if your symptoms persist or worsen. They may recommend further diagnostic procedures, such as an anoscopy, to assess the fissure and rule out other conditions.

In summary, while conservative measures may be effective for some individuals, your ongoing symptoms suggest that further evaluation and treatment may be necessary. Do not hesitate to reach out to your healthcare provider for a follow-up appointment to discuss your concerns and explore additional treatment options. Early intervention can prevent complications and promote healing, allowing you to return to a pain-free life.

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