Anal Fissures and Polyps: Pain, Healing, and Diagnosis

Anal fissure + polyp

I have seen questions related to anal fissures, but I still want to ask the doctor.
I have normal bowel movements every day, once a day.
A few months ago, I visited a doctor who prescribed medication and an ointment for me, and recommended sitz baths.
I finished the medication, and I have been applying the ointment daily, but I still experience pain during bowel movements.
The stool is hard at the front but soft at the back, which prevents the wound from healing.
I would like to ask the doctor: 1.
Is it difficult for anal fissures to heal, so is it normal that it hasn't healed after such a long time? 2.
Will there be polyps around the anal fissure? (Previously, when I visited the doctor, they mentioned that I might have an infection resembling genital warts.
I applied Aldara, and it has reduced in size, but after using the restroom, it feels like the polyp comes back.
I have been unable to distinguish whether it is genital warts, hemorrhoids, or a small polyp from the anal fissure.) I have quite a few questions, thank you for your patience in reading them.

Niming, 20~29 year old female. Ask Date: 2016/08/30

Dr. Ke Fangxu reply Surgery

1.
& 2.
These are considered normal; however, it is important to improve bowel habits.
3.
Whether it is a wart or a polyp can only be confirmed through a personal examination.
Otherwise, we need to observe for a period of time: if the size increases and the area expands, it is likely a wart; if there are no significant changes, it is likely a polyp.

Reply Date: 2016/08/30

More Info

Anal fissures are small tears in the lining of the anus, often caused by passing hard stools, straining during bowel movements, or chronic diarrhea. They can lead to significant pain, especially during and after bowel movements, and can sometimes be accompanied by bleeding. The healing process for anal fissures can be prolonged, particularly if the underlying causes are not addressed.

1. Is it normal for anal fissures to take a long time to heal?
Yes, it is not uncommon for anal fissures to take a long time to heal, especially if the initial causes of the fissure are still present. Factors such as ongoing constipation, hard stools, or straining can prevent the fissure from healing properly. In some cases, fissures can become chronic, meaning they do not heal and may require more intensive treatment. It's crucial to maintain a diet high in fiber, stay hydrated, and possibly use stool softeners to ensure that bowel movements are easier and less painful.
2. Can anal fissures lead to the formation of polyps or tags?
Yes, the tissue surrounding a chronic anal fissure can develop what are known as skin tags or anal tags. These are benign growths that can occur as a result of the healing process. However, if there is a concern about the presence of warts (which could indicate a condition like HPV), or if you suspect that you have hemorrhoids, it is essential to consult a healthcare professional for an accurate diagnosis. Distinguishing between skin tags, hemorrhoids, and warts can be challenging, and a healthcare provider can perform a physical examination to clarify the situation.

Diagnosis and Treatment:
To diagnose an anal fissure, a healthcare provider will typically perform a physical examination, which may include a visual inspection of the anal area. In some cases, a digital rectal exam may be performed to assess the area further. If there are concerns about other conditions, such as warts or polyps, additional tests may be necessary.

Treatment for anal fissures often includes:
- Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements.

- Hydration: Drinking plenty of water can help keep stools soft.

- Topical Treatments: Medications such as nitroglycerin ointment or calcium channel blockers can help relax the anal sphincter and promote healing.

- Sitz Baths: Soaking in warm water can help relieve pain and promote healing.

- Pain Management: Over-the-counter pain relievers can help manage discomfort.

- Surgery: In cases where conservative treatments fail, surgical options such as lateral internal sphincterotomy may be considered to relieve tension in the anal sphincter and promote healing.

If you are experiencing persistent pain and discomfort, it is essential to follow up with your healthcare provider. They can provide a tailored treatment plan and monitor your progress. If you notice any changes in the appearance of the anal area, such as new growths or changes in existing ones, it is crucial to seek medical advice promptly to rule out any serious conditions.
In summary, while anal fissures can be challenging to heal, with appropriate management and lifestyle changes, many individuals can find relief and promote healing. If you have concerns about the nature of any growths or persistent symptoms, do not hesitate to consult a healthcare professional for further evaluation and treatment options.

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