Managing Recurring Anal Fissures: Effective Strategies for Healing

What to do if mild anal fissures recur?

Since being diagnosed with an anal fissure in early February of this year, I have seen significant improvement after using medication.
However, when I do not pay attention and my stools become harder, I experience bleeding or pain.
I then start applying medication again, and after one or two weeks, there is no bleeding and minimal pain, so I stop using the medication.
Unfortunately, within a few days, I suddenly experience pain or bleeding again during bowel movements.
This cycle continues: I apply medication for another week or two, and the bleeding and pain subside, but then I stop, and the pain or bleeding returns after a few days.
Each month, I have several days (3-5 days) of painful bowel movements or bleeding.
When I visit the hospital, they say there are some wounds but they are minor.
I feel much better, but then I get injured again.
My stools are not hard, but I do not understand why I keep getting injured.
It is not severe enough to require surgery, but the discomfort after an injury is bothersome.
1.
Does this cycle of improvement and injury indicate that I have a chronic condition?
2.
I drink 2000cc of water daily, have bowel movements once in the morning and once at night, wash with clean water, avoid fried and irritating foods, and do not stay up late.
However, the wounds keep recurring, which causes psychological stress because I do not know if today’s bowel movement will be painful.

What are some ways I can truly heal? Thank you, doctor.

Xiao Xiao Gong Wu Yuan, 30~39 year old female. Ask Date: 2017/08/14

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like the typical symptoms of an anal fissure, which 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, along with warm sitz baths, which can alleviate pain and promote healing.
You can also purchase over-the-counter hemorrhoid suppositories for use.
If symptoms persist without improvement, it is advisable to consult a physician for further evaluation.

Reply Date: 2017/08/14

More Info

Managing recurring anal fissures can be quite challenging, especially when the cycle of healing and re-injury continues. Your experience of having periods of improvement followed by pain and bleeding is indicative of a chronic condition, which can be frustrating and stressful. Let's address your concerns and explore effective strategies for healing.

1. Understanding Chronic Anal Fissures: Yes, the pattern you describe does suggest that you are dealing with a chronic anal fissure. Chronic fissures often result from repeated trauma to the anal canal, which can be caused by hard stools, straining during bowel movements, or even the healing process itself if the area remains sensitive. The fact that you experience pain and bleeding after seemingly normal bowel movements indicates that the fissure may not be fully healed, or that there are underlying factors contributing to its recurrence.

2. Hydration and Diet: You mentioned that you drink 2000cc of water daily and maintain a relatively healthy diet, avoiding fried and irritating foods. This is excellent, as hydration is crucial for softening stools. However, it might be beneficial to further evaluate your diet. Incorporating more fiber-rich foods such as fruits, vegetables, whole grains, and legumes can help ensure that your stools remain soft and easy to pass. Consider consulting with a dietitian for personalized dietary advice.

3. Bowel Habits: Regular bowel habits are important, but it's also essential to avoid straining. If you find yourself straining during bowel movements, it may be helpful to use a stool softener or a fiber supplement to ease the process. Additionally, establishing a routine for bowel movements can help, but avoid forcing yourself if you don't feel the urge.

4. Topical Treatments: You mentioned using topical medications, which can be effective in managing pain and promoting healing. However, it's crucial to use these consistently as prescribed. If you find that your current treatment isn't providing lasting relief, discuss with your healthcare provider the possibility of trying different topical agents, such as nitroglycerin ointment or calcium channel blockers, which can help relax the anal sphincter and promote healing.

5. Sitz Baths: Regular sitz baths can provide relief and promote healing. Soaking in warm water for about 10-15 minutes several times a day can help soothe the area and improve blood flow, which is essential for healing.

6. Stress Management: The psychological impact of dealing with recurring pain and discomfort should not be underestimated. Consider incorporating stress management techniques such as mindfulness, meditation, or gentle yoga to help alleviate anxiety related to bowel movements.

7. Follow-Up Care: Since your condition is chronic, regular follow-ups with your healthcare provider are essential. They can monitor your healing progress and make necessary adjustments to your treatment plan. If conservative measures fail, they may discuss other options, including minimally invasive procedures that can help promote healing.

In conclusion, managing recurring anal fissures requires a multifaceted approach that includes dietary modifications, consistent use of topical treatments, proper bowel habits, and stress management. While it can be a frustrating journey, with the right strategies and support, you can work towards achieving lasting relief and healing. If you continue to experience difficulties, don't hesitate to seek further medical advice to explore additional treatment options.

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