Anal Fissures: Symptoms, Treatment, and When to Seek Help

The issue of anal fissures?

Hello, Doctor: Recently, I had sexual intercourse with a male partner (with a condom), and due to insufficient lubrication, my anus was injured.
The same day and the next day were fine; urination and bowel movements were relatively normal and not very painful.
However, on the third day, I woke up feeling a lot of pain, so I went to the pharmacy and bought the hemorrhoid suppositories that a doctor had previously prescribed for me when I had an anal fissure, but there was no improvement.
I started to feel significant pain while urinating due to the contraction of the sphincter, making it nearly impossible to urinate normally.
I still managed to urinate completely once in the evening and once in the afternoon.
Later, I decided to visit a general surgeon, who specialized in colorectal surgery.
He examined me with his finger and the thinnest colonoscope and said it wasn't as serious as I imagined.
However, I still felt some discomfort whether sitting or standing; only lying in bed at home was somewhat comfortable.
He prescribed anti-inflammatory medication, a stool softener, and hemorrhoid ointment, and advised me to stop using the suppositories.
Now, on the third day of medication, I still cannot urinate normally and can only endure the pain of contracting the sphincter while slowly finishing urination, which usually takes about 20 minutes.
My anus is now noticeably swollen, and I am applying the medication only a little on the outside and inside (as directed by the doctor).
It feels more comfortable right after applying the medication, and lying in bed helps reduce the pain, but getting up from bed is a nightmare.
Today, I went to school for an exam, and when my classmate gave me a ride on a scooter, I felt a lot of pain getting on the back seat.
I couldn't walk there because it was a bit far, and my mobility is limited; walking is painful.
During the exam, I had to sit for a long time, and I endured the pain for a long time to finish and submit my paper, which resulted in extreme pain afterward.
I was in so much pain that I cried, and I don't know what to do.
Now, I am lying in bed writing to you, hoping you can answer my questions.
My diet has been lighter these past few days; I have been trying to eat white toast with some digestive juice.
I saw another article where someone had similar swelling and pain in the anus, and felt pain while urinating due to sphincter contraction.
After seeing a doctor, he found that the wound had pus, which led to a drainage procedure, and his condition improved significantly.
I wonder if I should consider seeing another doctor as well? I am a bit puzzled because the doctor said my condition doesn't look that serious and that a week of medication without a follow-up would suffice.
Is that really true...? I am currently in a lot of pain and am worried that not being able to urinate could cause damage to my bladder or urethra...

Xiao Ming, 10~19 year old female. Ask Date: 2016/10/25

Dr. Ke Fangxu reply Surgery

Based on your description, it seems to be a typical symptom of anal fissure, which is characterized by pain during bowel movements accompanied by slight bleeding.
If there is concurrent bleeding from hemorrhoids, the amount of blood may be greater.
Severe anal fissures or those associated with bacterial infections can also affect urination.
It is recommended to take warm sitz baths to alleviate symptoms, and topical ointments and suppositories can be used for treatment.
If the pain is severe or if urination is difficult, oral medications may also be necessary.
If symptoms persist for more than a week without improvement, it is advisable to consult a physician to identify the underlying issue, and a sigmoidoscopy may be performed to check for any damage to the lower rectum.

Reply Date: 2016/10/25

More Info

Anal fissures are small tears in the lining of the anal canal, often resulting from trauma, such as during bowel movements or, as in your case, from friction during sexual activity. The symptoms you are experiencing, including pain during urination and bowel movements, swelling around the anal area, and difficulty sitting or standing, are common indicators of an anal fissure.
In your situation, it seems that the initial injury may have led to inflammation and possibly a spasm of the anal sphincter, which can exacerbate pain and make urination difficult. The fact that you are experiencing significant discomfort, especially when trying to urinate, suggests that the fissure may be causing a reflexive tightening of the sphincter muscle, leading to increased pain and difficulty in urination.

The treatment you received, including anti-inflammatory medication, stool softeners, and topical ointments, is standard for managing anal fissures. These treatments aim to reduce inflammation, promote healing, and alleviate pain. However, if you are not experiencing relief after a few days of treatment, it may be necessary to reassess your condition.

Here are some important points to consider regarding your situation:
1. Follow-Up Care: Since you are still experiencing significant pain and difficulty urinating, it would be wise to follow up with a healthcare provider, preferably a specialist in colorectal surgery. They can perform a more thorough examination and determine if there are any complications, such as an infection or abscess, that may require additional treatment.

2. Signs of Infection: You mentioned that your anal area is swollen. If you notice any signs of infection, such as increased redness, warmth, or discharge, it is crucial to seek medical attention promptly. An abscess can develop if an anal fissure becomes infected, and this may require drainage.

3. Pain Management: Managing pain is essential for recovery. If the prescribed medications are not providing adequate relief, discuss this with your doctor. They may adjust your pain management plan or recommend additional treatments, such as sitz baths, which can help soothe the area.

4. Dietary Considerations: Maintaining a diet high in fiber and staying well-hydrated can help prevent constipation and reduce strain during bowel movements, which is crucial for healing. Continue to focus on a diet that promotes soft stools.

5. Avoiding Strain: It’s important to avoid straining during bowel movements and urination. If you find it difficult to urinate, try to relax and take your time. Stressing about urination can lead to further sphincter spasms and increased pain.

6. Potential Surgical Options: If conservative treatments do not lead to improvement, surgical options may be considered. These can include procedures to relax the anal sphincter or to remove any excess tissue that may be causing pain.

7. When to Seek Emergency Care: If you experience severe pain that is unmanageable, notice any significant changes in your bowel or urinary habits, or if you develop fever or chills, seek emergency medical care.

In summary, while your doctor may have assessed your condition as not severe, your ongoing symptoms suggest that further evaluation is warranted. It’s essential to communicate openly with your healthcare provider about your pain levels and any concerns you have. Don’t hesitate to seek a second opinion if you feel your current treatment plan is not addressing your needs effectively. Your comfort and health are paramount, and there are various options available to help you find relief.

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