Anal fissure or enteritis?
Hello Dr.
Ke: Since March, I have been experiencing severe pain in my anal area after using the bathroom, feeling like a knife is cutting me, and the pain lasts for a long time.
Therefore, I went to a major hospital for consultation.
The doctor performed a digital examination and an anoscopy and diagnosed me with an anal fissure.
They advised me to eat more fruits and vegetables, but even after increasing my daily intake, I still experience severe pain after bowel movements, which causes cold sweats and my face to turn pale.
Now, I am afraid to have a bowel movement; I get anxious as soon as I feel the urge.
Later, I sought help at another hospital, where the doctor instructed me to perform daily sitz baths and to manually dilate my anus with my fingers to make it larger so that bowel movements would not be painful.
However, if I cannot dilate it, surgery may be necessary.
But since I am currently breastfeeding, many treatment medications are not an option.
After returning home, I tried this method, but even inserting my finger a little caused so much pain that I could not proceed further.
The pain is primarily on the left side of my anus.
I have read that anal fissures in women typically occur in the midline at the back, but my pain is on the left side.
I found information stating that if there is pain on both sides, it is necessary to check for gastrointestinal inflammation.
Therefore, I would like to ask Dr.
Ke: 1.
Is self-dilation of the anus effective? Will bowel movements be painless in the future? 2.
If an anal fissure heals, does it mean that improving bowel habits and having soft stools daily will lead to healing? 3.
Should I consider seeing a gastroenterologist?
Jing, 20~29 year old female. Ask Date: 2017/06/02
Dr. Ke Fangxu reply Surgery
1.
Anal dilation is indeed one of the traditional treatments for anal fissures; however, it is generally considered to be ineffective and painful.
If you can tolerate it, you might consider trying it.
2.
The typical symptoms of an anal fissure include pain during bowel movements accompanied by slight bleeding.
The common causes are often constipation or diarrhea.
The fundamental treatment is to improve bowel habits, and warm sitz baths can also be helpful.
Over-the-counter hemorrhoid suppositories can be purchased for use.
If symptoms persist without improvement, it is advisable to consult a physician.
3.
It is recommended to seek treatment from a colorectal surgeon.
Reply Date: 2017/06/02
More Info
Anal fissures are a common condition characterized by a tear in the lining of the anal canal, often resulting in severe pain during bowel movements. The pain can be so intense that it may lead to anxiety about having a bowel movement, which can create a vicious cycle of constipation and further pain. Your experience of severe pain, especially after using the restroom, is consistent with this condition.
1. Self-Dilation of the Anus: The practice of self-dilation, as suggested by your doctor, can be effective in some cases. The goal is to gradually stretch the anal sphincter to reduce the pain associated with bowel movements. However, this should be done with caution. If the pain is too severe to allow for any dilation, it may be necessary to explore other options first. It’s important to approach this method gently and to ensure that you are not causing further injury or discomfort. If you find it too painful to proceed, it may be best to consult a healthcare professional for alternative methods of treatment.
2. Healing of Anal Fissures: For an anal fissure to heal, it is crucial to maintain soft stools and avoid straining during bowel movements. Increasing dietary fiber, as you have been doing, is an essential step. Additionally, staying hydrated and possibly using stool softeners can help. If the fissure is acute and the underlying causes (like constipation) are addressed, it can heal on its own. However, chronic fissures may require more intensive treatment, including topical medications or surgical options if conservative measures fail.
3. Consulting a Gastroenterologist: Given your ongoing pain and the specific location of the fissure, it may be beneficial to consult a gastroenterologist. They can perform a more thorough evaluation to rule out any underlying gastrointestinal issues, such as inflammatory bowel disease or other conditions that could contribute to your symptoms. Additionally, they can provide specialized treatment options that may not be available through a general practitioner.
In terms of pain management, topical treatments such as nitroglycerin ointment or calcium channel blockers can help relax the anal sphincter and promote healing. Sitz baths, which involve soaking the anal area in warm water, can also provide relief and promote healing by increasing blood flow to the area.
If you are breastfeeding, it is understandable that you are concerned about medication use. Many topical treatments for anal fissures are considered safe during breastfeeding, but it is always best to discuss any medications with your healthcare provider to ensure they are appropriate for your situation.
In summary, managing anal fissures involves a combination of dietary changes, pain management strategies, and possibly medical interventions. If self-dilation is too painful, focus on maintaining soft stools and consider consulting a gastroenterologist for further evaluation and treatment options. Your health and comfort are paramount, and addressing these issues proactively can lead to significant improvements in your quality of life.
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