Managing Anal Fissures: Effective Use of Topical Treatments

Application of rectal ointment?

Hello, Dr.
Ko.
Since July of this year, I have been experiencing pain and bleeding during bowel movements, with symptoms that fluctuate.
There is a swollen, yellowish lump outside my anus.
Initially, I thought it was hemorrhoids, and in August, I purchased a suppository from Takeda Pharmaceutical and used it for about 20 days.
However, in September, since the condition did not improve, I visited a large hospital's colorectal surgery department.
The doctor performed a digital examination and an anoscopy, diagnosing me with a fissure.
He applied a very painful ointment and prescribed a tube of gentamicin from a biotech company.
I would like to ask the following questions:
1.
The doctor advised me to use gentamicin to soften the anus before each bowel movement, but this ointment seems to be an external antibiotic.
If I have more than two bowel movements a day, can I continue to apply it?
2.
The doctor also mentioned that I could use petroleum jelly for lubrication.
How should I use gentamicin and petroleum jelly together?
3.
Last night, I tried using a cotton swab to apply the medication, and after withdrawing it from the anus, there was brownish pus and blood on the swab.
When I woke up, there was also some on my underwear.
However, I cannot see any wounds externally.
How should I clean and apply the medication in this situation?
I apologize for asking so many questions.
I have been trying to adjust my routine and diet in hopes of improving my condition to avoid surgery.
Thank you for your patient responses!

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

Dr. Ke Fangxu reply Surgery

1 & 2.
The main function of this ointment is the petroleum jelly component, which serves as a lubricant.
Since petroleum jelly is not classified as a medication, this ointment is eligible for health insurance coverage.
Therefore, either option can be applied.
3.
It is acceptable to use a cotton swab or to use a finger to apply the ointment inside the anus.
4.
In this situation, taking warm water sitz baths can help relax the anal area and maintain cleanliness.
Switching to hemorrhoid ointment can improve symptoms of bleeding and pain.

Reply Date: 2017/09/06

More Info

Managing anal fissures can be a challenging and uncomfortable experience, but with the right approach and treatment, significant relief can be achieved. Anal fissures are small tears in the lining of the anus, often caused by passing hard stools, and can lead to pain, bleeding, and discomfort during bowel movements. Here’s a comprehensive response to your questions regarding the effective use of topical treatments for managing anal fissures.

1. Use of Antibiotic Ointment (欣黴素): Your doctor has prescribed an antibiotic ointment, which is typically used to prevent infection in the fissure area. While it is important to keep the area clean and free from infection, using the ointment multiple times a day, especially if you have more than two bowel movements, is generally acceptable. However, it is crucial to monitor for any signs of irritation or allergic reactions. If you notice increased pain or discomfort, it may be wise to consult your healthcare provider for further guidance. In general, applying the ointment before each bowel movement can help soften the stool and protect the fissure from further injury.

2. Using Vaseline in Conjunction with Antibiotic Ointment: Vaseline (petroleum jelly) can be an effective lubricant that helps to reduce friction during bowel movements. You can use it in conjunction with the antibiotic ointment. A good approach would be to apply the antibiotic ointment first, allowing it to absorb for a few minutes, and then apply a thin layer of Vaseline over it. This combination can provide a protective barrier, making bowel movements less painful. It is essential to ensure that the area is clean before applying any ointments to prevent introducing bacteria.

3. Managing Bleeding and Cleaning: The presence of coffee-colored discharge or blood on the cotton swab after applying the ointment may indicate that the fissure is still active and possibly bleeding. It is important to keep the area clean to prevent infection. After a bowel movement, gently clean the area with warm water and mild soap, avoiding harsh scrubs or wipes that can irritate the skin. Pat the area dry with a soft towel rather than rubbing it. If you notice persistent bleeding or if the discharge increases, it is advisable to contact your healthcare provider for further evaluation.

In addition to topical treatments, consider the following supportive measures to promote healing and prevent further fissures:
- Dietary Adjustments: Increase your fiber intake through fruits, vegetables, and whole grains to help soften stools. Staying well-hydrated is also crucial, as it can help prevent constipation and reduce the strain during bowel movements.

- Sitz Baths: Taking warm sitz baths for about 10-15 minutes several times a day can help soothe the area, promote blood flow, and aid in healing.

- Avoid Straining: When using the bathroom, try not to strain or sit for prolonged periods. If you feel the urge to go, do so promptly.

- Over-the-Counter Stool Softeners: If dietary changes are not sufficient, consider using over-the-counter stool softeners to ease bowel movements.

- Follow-Up Care: Regular follow-ups with your healthcare provider are essential to monitor the healing process and adjust treatment as necessary.

In conclusion, managing anal fissures effectively requires a combination of topical treatments, dietary changes, and good hygiene practices. If your symptoms persist or worsen, do not hesitate to seek further medical advice. Your proactive approach to adjusting your lifestyle and seeking treatment is commendable and can lead to improved outcomes.

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