Hemorrhoids and Anal Fissures: Symptoms and Treatment Options

Hemorrhoids and anal fissures?

-----Symptom History------ Six years ago, I experienced bloody stools with a strong odor.
I visited a doctor, took stool softeners, and changed my diet, which resolved the issue within a week.
Two years ago, due to irregular eating and sleeping habits, I had bleeding again (with a spraying sensation) and felt like there was still something in my anus during bowel movements.
A colonoscopy was performed, and the doctor diagnosed me with mild internal hemorrhoids.
Recently, over the past month, the symptoms have become more pronounced.
I often feel that my stools are very hard (also with the sensation of something remaining in the anus), and there is pain as if the anus is being stretched.
I noticed some bright red blood when wiping with toilet paper, and when using a bidet, I feel a stinging sensation both outside and inside the anus.
Two days ago: after a bowel movement, there was dripping blood, and straining continued to cause dripping blood.
Yesterday: I passed two small, thick segments with a bit of blood, and there was blood at the break point of the stool.
Today: I had a larger quantity of brown stool in various sizes, which came out easily without straining.
--------Lifestyle Habits--------- I have bowel movements approximately every two days, and I drink about 1000 cc of water daily.
When busy, I tend to eat fewer vegetables and fruits.
I usually do not experience abdominal pain, and this month I have been getting about six hours of sleep per night.
--------Doctor, do I need to have another colonoscopy? Is the stinging sensation when using the bidet indicative of an anal fissure? I can only see a doctor next week; is there anything else I should observe in the meantime? Thank you, doctor.

Chen, 20~29 year old female. Ask Date: 2018/03/16

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hemorrhoids and anal fissures fall under the category of colorectal surgery.

Reply Date: 2018/03/16

More Info

Understanding hemorrhoids and anal fissures is crucial for managing symptoms and determining appropriate treatment options. Based on your symptoms and history, it seems you may be experiencing a combination of both conditions, which are common and can significantly impact quality of life.

Symptoms Overview
From your description, you have experienced rectal bleeding, pain during bowel movements, and a sensation of incomplete evacuation. These symptoms are indicative of hemorrhoids, particularly internal hemorrhoids, which can cause bleeding and discomfort. The presence of sharp pain and bleeding during bowel movements may also suggest an anal fissure, which is a small tear in the lining of the anus that can occur due to passing hard stools.

Treatment Options
1. Dietary Changes: Since you mentioned a busy lifestyle that leads to inadequate fruit and vegetable intake, focusing on a high-fiber diet is essential. Aim for at least 25-30 grams of fiber daily to help soften stools and reduce straining during bowel movements. Incorporating more fruits, vegetables, whole grains, and legumes can help achieve this goal.
2. Hydration: Increasing your water intake is also vital. Aim for at least 2 liters (about 8 cups) of water daily, as proper hydration can help prevent constipation and promote regular bowel movements.

3. Stool Softeners and Laxatives: Over-the-counter stool softeners (like docusate sodium) can be beneficial in easing bowel movements. If necessary, a gentle laxative may be used occasionally to relieve constipation, but it should not be relied upon long-term.

4. Topical Treatments: For hemorrhoids, topical treatments such as hydrocortisone creams or witch hazel pads can help reduce inflammation and discomfort. For anal fissures, topical anesthetics or nitroglycerin ointment may be prescribed to relieve pain and promote healing.

5. Warm Sitz Baths: Taking warm baths several times a day, especially after bowel movements, can help soothe the anal area and promote healing. This practice can also alleviate discomfort associated with both hemorrhoids and fissures.

6. Avoid Straining: It’s crucial to avoid straining during bowel movements, as this can exacerbate both conditions. If you feel the urge to go, try to respond promptly rather than waiting, as delaying can lead to harder stools.

When to Seek Further Evaluation
Given your history and current symptoms, it may be prudent to consider a follow-up colonoscopy, especially if you notice any changes in your bowel habits or if the bleeding persists. While your previous colonoscopy indicated only mild internal hemorrhoids, the recurrence of symptoms and the presence of pain and bleeding warrant further investigation to rule out any other underlying conditions.

Anal Fissure Consideration
The sharp pain and bleeding you experience, particularly when using a bidet, could indeed indicate an anal fissure. The pain associated with fissures is often described as a sharp, burning sensation during and after bowel movements. If you suspect a fissure, it’s important to address it promptly, as untreated fissures can become chronic and more difficult to heal.

Conclusion
In summary, managing hemorrhoids and anal fissures involves dietary modifications, proper hydration, topical treatments, and lifestyle adjustments. Observing your symptoms closely and seeking medical advice when necessary is crucial. If your symptoms persist or worsen, or if you experience significant changes in bowel habits, a follow-up with your healthcare provider is recommended. They may suggest further diagnostic tests, such as a colonoscopy, to ensure there are no other underlying issues. In the meantime, focus on maintaining a healthy diet, staying hydrated, and practicing good bowel habits to alleviate your symptoms.

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