Chronic Anal Fissures: Symptoms, Treatment, and Surgery Options

Anal fissure issues?

Hello, doctor.
I have been experiencing symptoms of anal fissures for a while.
Occasionally, when I have a bowel movement, it hurts a bit, and there is bleeding.
The amount of blood varies; sometimes it's just a little, and other times it's more.
Usually, the front part of the stool is a bit larger, while the back end is softer.
A previous doctor mentioned that I also have symptoms of internal hemorrhoids, which can be intermittent.
Sometimes I don’t have issues, but at other times, I experience bleeding from the fissure.
I usually take warm sitz baths twice a day and have been supplementing with probiotics, yogurt, water, and fiber.
I would like to know if surgery is the only solution to resolve this issue.
Have I developed chronic anal fissures?

Chen Chen, 30~39 year old female. Ask Date: 2016/08/29

Dr. Ke Fangxu reply Surgery

If anal fissures persist for more than three months without improvement, they can be classified as chronic anal fissures.
If symptoms can be alleviated through dietary changes and improved bowel habits, surgery may not be necessary.
However, if symptoms continue to be bothersome and do not improve significantly, surgical treatment may be a more effective option for immediate relief.

Reply Date: 2016/08/29

More Info

Chronic anal fissures are a common condition that can cause significant discomfort and distress. They are characterized by a tear in the lining of the anal canal, often resulting in pain during bowel movements, bleeding, and sometimes itching or irritation. The symptoms you describe—pain during defecation, occasional bleeding, and the presence of hemorrhoids—are consistent with chronic anal fissures.

Symptoms of Chronic Anal Fissures
1. Pain: This is typically sharp and occurs during and after bowel movements. The pain can last for several hours.

2. Bleeding: Bright red blood may be seen on the toilet paper or in the toilet bowl, usually associated with the passage of hard stools.

3. Itching or Irritation: The area around the anus may become itchy or irritated due to the fissure or associated conditions like hemorrhoids.

4. Tightness or Spasms: Some patients experience anal sphincter spasms, which can exacerbate pain and discomfort.

Treatment Options
The management of chronic anal fissures often begins with conservative measures. Here are some common approaches:
1. Dietary Modifications: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements. Adequate hydration is also essential.

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

3. Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone or other soothing agents can provide relief. Prescription medications like nitroglycerin ointment or calcium channel blockers (e.g., diltiazem) may help relax the anal sphincter and promote healing.

4. Stool Softeners: These can help prevent hard stools and reduce the pain associated with bowel movements.

Surgical Options
If conservative treatments fail to provide relief, surgical options may be considered. Surgery is typically recommended for chronic fissures that do not heal with conservative management. The most common surgical procedure is lateral internal sphincterotomy, which involves cutting a small portion of the anal sphincter muscle to relieve tension and promote healing. This procedure has a high success rate and can significantly reduce pain and promote healing.

When to Consider Surgery
You may be considered to have chronic anal fissures if your symptoms have persisted for more than six weeks despite conservative treatment. If you find that your quality of life is significantly affected, or if you experience recurrent episodes of fissures, it may be time to discuss surgical options with your healthcare provider.

Conclusion
In summary, while many patients with chronic anal fissures can find relief through conservative measures, surgery may be necessary for those who do not respond to these treatments. It is essential to have a thorough discussion with your healthcare provider about your symptoms, treatment options, and the potential benefits and risks of surgery. Your healthcare provider can help you determine the best course of action based on your specific situation and the severity of your condition.

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