Persistent Anal Itching After Fissure and Scar Tissue

Anal itching

Hello Doctor, I was diagnosed with anal fissures and mild hemorrhoids at Lixin Hospital in early February this year.
I experienced severe pain during bowel movements.
After applying ointment and taking warm sitz baths, the pain during bowel movements subsided.
However, after two weeks, I started to experience bleeding again, along with itching in the anal area.
I continued applying the ointment for three weeks, but once I stopped, the bleeding returned.
I then continued the ointment for another month, and by late April to early May, I had intermittent bleeding and daily itching.
I went to see a doctor again, who noted that there was a tear at the anal opening that might heal on its own, but advised against warm sitz baths, as exposure to water could hinder healing.

At the end of May, due to persistent itching in the anal area, I consulted a specialist at Zhongxing Hospital.
The doctor mentioned that there was scar tissue in the anal area and that the fissure should have healed.
He prescribed medication for the hemorrhoids.
However, after applying the ointment, the injured area still itched a lot.
Therefore, I visited another doctor in early June.
After the examination, the doctor said the cause was unclear, as the hemorrhoids were very mild, and while there was scar tissue in the anal area, there were no abnormalities.

I am no longer using the ointment, and there is no bleeding, and bowel movements are not very painful.
However, the injured area continues to itch daily, and sometimes even the inner thighs feel uncomfortable.
This has persisted for over three months.
I would like to ask if the itching could be due to the scar tissue.
Thank you very much.

Shangbanzu, 30~39 year old female. Ask Date: 2017/06/09

Dr. Ke Fangxu reply Surgery

Anal itching may be caused by excessive wiping and will not result in swelling due to damage to the sphincter muscle.
In addition to medication and topical treatments, there are three important things to keep in mind: avoid scratching to prevent wound infection, temporarily refrain from consuming spicy foods to prevent capsaicin from irritating the skin, and avoid using soap or body wash to clean the anal area to prevent excessive removal of the skin's natural oils.
If these points are followed, improvement can generally be seen in about a week.

Reply Date: 2017/06/09

More Info

Persistent anal itching following a fissure and the formation of scar tissue can be a frustrating and uncomfortable experience. Based on your description, it seems that you have undergone a significant healing process after being diagnosed with an anal fissure and mild hemorrhoids. While the initial pain during bowel movements has subsided, the ongoing itching and occasional bleeding suggest that there may still be underlying issues that need to be addressed.

Firstly, it is important to understand that anal fissures can lead to the development of scar tissue as they heal. This scar tissue can sometimes be sensitive and may cause discomfort or itching. The itching you are experiencing could indeed be related to the scar tissue itself. Scar tissue is often less flexible than normal skin and can be more prone to irritation, especially in a sensitive area like the anal region. Additionally, the presence of scar tissue can sometimes lead to a condition known as pruritus ani, which is characterized by itching around the anus.

Another possibility is that the itching could be due to residual inflammation or irritation from the initial fissure or from the hemorrhoids. Even after the fissure has healed, the surrounding tissue may still be sensitive or inflamed, leading to persistent itching. It is also worth considering that hygiene practices can play a role in this discomfort. Over-washing or using harsh soaps can irritate the area, while inadequate cleaning can lead to irritation from residual stool or moisture.

Moreover, if you have been using topical medications, it is essential to note that some ingredients in these products can cause irritation or allergic reactions, contributing to the itching sensation. If you have stopped using the medication and the itching persists, it might be worth discussing alternative treatments or topical agents with your healthcare provider.

In terms of management, here are some recommendations that may help alleviate your symptoms:
1. Gentle Hygiene Practices: Ensure that you are cleaning the area gently after bowel movements. Using unscented wipes or a soft cloth with warm water can help. Avoid using soap directly on the area, as it can cause irritation.

2. Moisturizing: Applying a gentle, fragrance-free moisturizer to the area may help soothe the skin and reduce itching. Products containing ingredients like aloe vera or vitamin E can be beneficial.

3. Avoid Irritants: Be cautious with any products you apply to the area, including creams or ointments. If you suspect that a particular product is causing irritation, discontinue its use.

4. Dietary Considerations: Ensure that your diet is high in fiber to promote soft stools and reduce straining during bowel movements. Staying hydrated is also crucial.

5. Consultation with a Specialist: If the itching persists despite these measures, it may be beneficial to consult a gastroenterologist or a colorectal specialist. They can perform a thorough examination to rule out any other underlying conditions, such as infections or skin disorders.

6. Scar Tissue Treatment: In some cases, treatments such as topical steroids or other medications may be recommended to help reduce inflammation and itching associated with scar tissue.

In conclusion, while the itching you are experiencing may be related to scar tissue from your previous fissure, it is essential to rule out other potential causes. Persistent symptoms warrant further evaluation to ensure that there are no underlying issues that need to be addressed. Your healthcare provider can guide you through the appropriate steps to manage your symptoms effectively.

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