Symptoms: Are Hemorrhoids and Anal Fissures the Cause?

Is this hemorrhoids combined with anal fissure?

Hello, doctor.
I have been experiencing chronic constipation since childhood.
After a particularly painful experience with hard and large stools, I started using a handheld showerhead or water hose for enemas to soften my stools for easier passage.
Recently, I noticed a sharp, knife-like pain at the anal opening when water is introduced, and I observed some swelling around the area.
Additionally, I have excess skin at the anal opening that appears engorged and swollen after bowel movements.
Since then, whenever my stools are too hard or large (even if soft), I experience significant rectal bleeding.
As a result, I force myself to have a bowel movement at least every two days, avoid spicy foods, and take warm sitz baths for 10 minutes before using the toilet.
I also apply a water-based lubricant around the anal area.
Although this has improved my situation and I rarely bleed now, I still experience knife-like pain if the handheld showerhead accidentally sprays into a fold of the excess skin.
What could these symptoms indicate, doctor?

Xiang, 10~19 year old female. Ask Date: 2017/11/29

Dr. Ke Fangxu reply Surgery

Self-administering water into the rectum for irrigation is a very dangerous practice, and you should absolutely avoid doing this due to the risk of rectal perforation.
If this occurs, it could be life-threatening.
Additionally, inserting objects into the anus without proper lubrication can inevitably damage the anal tissue and hemorrhoidal structures, potentially leading to significant bleeding.
Over time, this can also result in injury to the sphincter muscles.
It is advisable to avoid constipation during this period and to shorten the time spent on the toilet.
Increasing your intake of dietary fiber can be beneficial.
Warm sitz baths may help alleviate symptoms, and you can also purchase hemorrhoid suppositories at the pharmacy.
It is best not to take stool softeners indiscriminately.
If bleeding persists, it is important to consult a physician for evaluation.

Reply Date: 2017/11/29

More Info

Hemorrhoids and anal fissures are common conditions that can cause significant discomfort and pain, particularly in individuals with a history of constipation, as you described. Based on your symptoms, it seems likely that you may be experiencing both hemorrhoids and anal fissures, which can occur concurrently and exacerbate each other.

Hemorrhoids are swollen veins in the lower rectum and anus, similar to varicose veins. They can be internal (inside the rectum) or external (under the skin around the anus). Symptoms of hemorrhoids can include:
1. Pain or discomfort: This is especially true during bowel movements or when sitting.

2. Bleeding: Bright red blood may appear on toilet paper, in the toilet bowl, or on the surface of the stool.

3. Swelling: You may notice a lump near your anus, which can be sensitive or painful.

4. Itching or irritation: This can occur around the anal area.

Anal fissures, on the other hand, are small tears in the lining of the anus, often caused by passing hard or large stools. Symptoms of anal fissures include:
1. Sharp pain: This is often described as a "knife-like" pain during and after bowel movements, which aligns with your experience.

2. Bleeding: Similar to hemorrhoids, you may notice blood on the toilet paper or in the stool.

3. Spasms: You might experience muscle spasms in the anal sphincter, which can increase discomfort.

Your practice of using a water hose or enema to soften stools is a common strategy for managing constipation, but it can also lead to irritation or trauma to the anal area, potentially worsening fissures or hemorrhoids. The swelling and the presence of excess skin (which may be a skin tag resulting from previous hemorrhoids) can also contribute to your symptoms.

Given your situation, here are some recommendations:
1. Dietary Changes: Increasing your fiber intake can help soften stools and reduce the strain during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial.

2. Topical Treatments: Over-the-counter creams or ointments designed for hemorrhoids can provide relief from pain and itching. These often contain hydrocortisone or witch hazel.

3. Sitz Baths: Continuing with warm sitz baths can help soothe the area and promote healing.

4. Avoid Straining: It’s important to avoid straining during bowel movements. If you feel the urge to go, try to respond promptly rather than delaying.

5. Consult a Specialist: If your symptoms persist or worsen, it would be wise to consult a gastroenterologist or a colorectal surgeon. They can perform a thorough examination and may recommend treatments such as prescription medications, minimally invasive procedures, or surgery if necessary.

6. Avoid Irritation: Be cautious when cleaning the anal area. Instead of using a hose, consider using moist wipes or a gentle rinse with water to avoid further irritation.

In summary, your symptoms suggest a combination of hemorrhoids and anal fissures, likely exacerbated by your history of constipation and the methods used to manage it. Implementing dietary changes, topical treatments, and proper hygiene practices can significantly improve your condition. However, seeking professional medical advice is essential for a tailored treatment plan and to rule out any other underlying issues.

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