Anal Fissures and First Degree Hemorrhoids: Your Questions Answered

Anal fissures and first-degree hemorrhoids?

Hello Dr.
Ke, I have some minor concerns I would like to ask you about.
Over the past few months, due to increased stress and a busy work schedule, my stools have become somewhat harder and bulkier.
Since April, I have experienced anal fissures twice.
After the second fissure, I felt a small lump at the anal area, sometimes accompanied by a sensation of prolapse, while other times I do not feel anything.
I visited the colorectal surgery department at Mackay Memorial Hospital, and the doctor diagnosed me with an anal fissure and first-degree hemorrhoids.
He mentioned that the fissure has healed and advised me not to worry too much, as long as I maintain good lifestyle habits, everything should be fine.
However, after observing my body over the past few days, I still have some questions, so I seek your help:
(1) My anal fissure has healed, but I still feel a slight itching sensation at the anal opening after bowel movements, although it is bearable.
Is this normal?
(2) Previously, my anal fissure was accompanied by two to three drops of blood and sharp pain, but the pain subsided after the bowel movement.
Is this serious? I have heard that anal fissures can reoccur in the same area, and sometimes deep squats or vigorous movements can cause them to reopen.
I have a fitness routine, and I am a bit concerned.
If I unfortunately experience recurrent fissures in the future, could there be serious complications?
(3) I have a habit of weight training; can I continue to lift weights with hemorrhoids?
(4) I smoke 3 to 4 cigarettes a day; could this worsen my hemorrhoids?
(5) Is it okay to take warm sitz baths during my menstrual period?
I apologize for asking so many questions, and I appreciate your help in clarifying these concerns.
Thank you.

W, 20~29 year old female. Ask Date: 2017/09/02

Dr. Ke Fangxu reply Surgery

1.
It is normal to experience slight itching during the healing of an anal fissure.
Scratching should be avoided to prevent infection; topical ointments can be applied to alleviate discomfort.

2.
There is no causal relationship between anal fissures and malignant tumors.

3.
Excessive abdominal straining can increase intra-abdominal pressure and anal pressure, which may exacerbate symptoms if hemorrhoids are present.
However, weight training can vary in intensity, and as long as it does not significantly increase abdominal pressure, it should not be a concern.

4.
In theory, it is permissible; if there are concerns, using a handheld showerhead for rinsing can be a suitable alternative.

Reply Date: 2017/09/02

More Info

Understanding anal fissures and first-degree hemorrhoids can be quite important, especially when dealing with discomfort and potential complications. Let's address your questions one by one.

1. Post-healing Symptoms: It's not uncommon to experience some residual sensations such as itching or a slight sting around the anal area after an anal fissure has healed. This can be due to increased sensitivity in the area or minor irritation from bowel movements. As long as the discomfort is manageable and not accompanied by significant pain or bleeding, it is generally considered normal. However, if the symptoms persist or worsen, it would be wise to consult your healthcare provider for further evaluation.

2. Severity of Symptoms: The symptoms you described during your previous fissure episodes, such as minor bleeding and pain during bowel movements, are characteristic of anal fissures. While they can be uncomfortable, they are not necessarily indicative of a severe condition. The key concern with anal fissures is their tendency to recur, especially if bowel habits are not managed properly. If you experience a recurrence, it is essential to maintain a high-fiber diet, stay hydrated, and possibly use stool softeners to prevent hard stools that can exacerbate the condition. Complications from recurrent fissures can include chronic pain or the development of a fistula, which is an abnormal connection between the anal canal and the skin.

3. Exercise with Hemorrhoids: Engaging in weight training or other forms of exercise is generally safe for individuals with first-degree hemorrhoids, provided that you listen to your body and avoid straining during workouts. Straining can exacerbate hemorrhoid symptoms, so focusing on proper form and breathing techniques during your workouts is crucial. If you notice increased discomfort during or after exercising, it may be beneficial to modify your routine or consult with a healthcare professional.

4. Smoking and Hemorrhoids: Smoking can potentially worsen hemorrhoid symptoms. It may contribute to poor circulation, which can affect the healing process and exacerbate symptoms. Additionally, smoking can lead to increased pressure in the abdominal area, which may aggravate hemorrhoids. Reducing or quitting smoking can have numerous health benefits, including improved vascular health and potentially alleviating some hemorrhoid symptoms.

5. Warm Sitz Baths During Menstruation: Taking warm sitz baths during your menstrual period is generally safe and can provide relief from discomfort associated with both menstrual cramps and hemorrhoids. The warmth can help soothe the area and promote relaxation. Just ensure that the water is at a comfortable temperature and that you maintain good hygiene practices.

In summary, managing anal fissures and hemorrhoids involves a combination of lifestyle modifications, dietary changes, and proper hygiene. Maintaining a high-fiber diet, staying hydrated, and avoiding straining during bowel movements are crucial steps in preventing recurrence. If you continue to experience symptoms or have concerns about your condition, it is always best to consult with your healthcare provider for personalized advice and treatment options. Remember, your health and comfort are paramount, and seeking professional guidance is a proactive step towards managing your symptoms effectively.

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