Anal Fissures: Symptoms, Treatments, and Management

Anal fissure issues?

Hello Doctor: Since late April to early May, after experiencing diarrhea, I began to have issues with anal fissures.
Initially, the pain was very severe, and about a week later, I visited a clinic for treatment.
After applying medication for about a week, I felt no discomfort.
However, I subsequently experienced hemorrhoids (the doctor mentioned grades I and II) with blood on toilet paper.
Until the week of June 14-15, after a bowel movement, I felt a tearing sensation at the anal area and started to experience slight pain again.
I returned for a follow-up, and the doctor recommended a combination of National Health Insurance medication and additional out-of-pocket pills for better results.
(On that day, the doctor also performed a digital examination and noted that there were no obvious wounds from the first examination, concluding that there were no fissures.) After taking the medication and applying ointment for about one to two weeks, it seemed that the cream caused severe eczema around the anal area.
On June 26, while I was in Taichung, I visited Chung Shan Hospital, where a colorectal surgeon assessed that it was an issue of external eczema and confirmed that there were no anal fissures.
After July 1, after a bowel movement, I felt a foreign body sensation at the anal area, which I couldn't quite describe.
It wasn't as painful as the anal fissures in early May, but there was a slight stinging sensation, a feeling of a foreign body, and swelling when I contracted the anal muscles.
I couldn't distinguish whether it was eczema, an anal fissure, or recurring hemorrhoids.
I returned to the clinic in Xindian, where a different doctor examined me and also stated that there were no anal fissures.
Each person's experience with hemorrhoids can vary, and even in the early stages, pain can occur.
Yesterday, I returned to the clinic because I noticed slight bleeding during a bowel movement and wanted to consider a banding procedure.
The doctor indicated that banding for mild hemorrhoids is not very effective and advised against it, recommending conservative treatment with medication.
He prescribed flavonoids, stating that they are for treating varicose veins, and he did not find any anal fissures during the examination.
When the doctor performed the examination, there was no pain internally, mainly a stinging sensation at the anal opening.
The doctor mentioned that after an anal fissure heals, the skin becomes thinner, which may lead to recurrent fissures, but currently, there are no fissures upon examination.
I apologize for the lengthy introduction, and I would like to ask: 1.
Three doctors have examined me and stated that there are no anal fissures, yet I still feel a slight tearing sensation during bowel movements, although it is not as painful as before, just a mild burning sensation.
Is this a matter of the skin being more sensitive after the healing of an anal fissure? 2.
Regarding the flavonoids, are they effective? The cost is quite significant.
3.
The doctor mentioned that I might have a naturally small pelvic structure, leading to higher anal pressure.
Is there any way to improve this (I take sitz baths twice a day)? 4.
Could the hemorrhoids be causing increased tightness in the anal area, leading to discomfort during bowel movements? Thank you for your patience in reading this.

Chen Xian, 20~29 year old female. Ask Date: 2017/07/07

Dr. Ke Fangxu reply Surgery

1.
If the stool is hard, experiencing pain during bowel movements is a normal phenomenon and does not necessarily indicate an anal fissure.

2.
If it is a self-paid purchase, I believe it is unnecessary because flavonoids are classified as food products and have not received medical recognition for the treatment of hemorrhoids.

3.
If there is indeed excessive anal pressure, one can try biofeedback therapy (covered by insurance).
If that is ineffective, a small number of physicians perform Botox injections (not covered by insurance); otherwise, surgery is the only option.

4.
Most cases are caused by poor bowel habits.

Reply Date: 2017/07/07

More Info

Anal fissures are small tears in the lining of the anus that can cause significant discomfort and pain, especially during bowel movements. Your experience with anal fissures, hemorrhoids, and associated symptoms is not uncommon, and I appreciate your detailed account of your medical journey. Let's address your questions one by one.

1. Sensitivity After Healing: It is possible that after an anal fissure heals, the skin around the anus can become more sensitive. This sensitivity can lead to a sensation of tearing or burning, especially during bowel movements. The healing process can cause the skin to thin, making it more susceptible to irritation. If you are experiencing a slight tearing sensation, it could be due to this increased sensitivity rather than an active fissure. It’s essential to maintain good hygiene and avoid any irritants that could exacerbate the sensitivity.

2. Effectiveness of Flavonoids: Flavonoids, such as those found in the medication your doctor prescribed, are often used to improve venous circulation and reduce inflammation associated with hemorrhoids. While they may not directly treat anal fissures, they can help alleviate symptoms related to hemorrhoids, which might be contributing to your discomfort. The effectiveness of flavonoids can vary from person to person, and while they are generally considered safe, it’s important to weigh their benefits against the cost. If you find that they help reduce your symptoms, they may be worth the investment.

3. High Anal Pressure and Structural Considerations: If your doctor has suggested that you may have a smaller pelvic structure leading to higher anal pressure, this could indeed contribute to your symptoms. High anal pressure can make bowel movements more difficult and painful, potentially leading to fissures and hemorrhoids. To improve this situation, consider dietary changes to ensure soft stools, such as increasing fiber intake and staying well-hydrated. Regular sitz baths, as you mentioned, can also help soothe the area and promote healing. Additionally, pelvic floor exercises may help in some cases by improving muscle tone and coordination.

4. Hemorrhoids and Discomfort: Hemorrhoids can indeed contribute to discomfort during bowel movements. They can cause swelling and pressure, which may lead to a feeling of tightness or discomfort when passing stool. If your hemorrhoids are inflamed, they can exacerbate the pain and discomfort associated with bowel movements, making it feel as though you have a fissure or other issue. Managing your hemorrhoids through dietary changes, topical treatments, and possibly medications can help alleviate this discomfort.

In summary, it seems that you are dealing with a combination of issues: healing from an anal fissure, managing hemorrhoids, and experiencing increased sensitivity in the anal region. It’s crucial to continue working with your healthcare providers to monitor your symptoms and adjust your treatment plan as necessary. If your symptoms persist or worsen, further evaluation may be warranted, including potential imaging or referral to a specialist for more targeted treatment options. Remember, maintaining a healthy diet, staying hydrated, and practicing good bowel habits are key components in managing and preventing future issues.

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