Managing Anal Fissures: Treatment Options and Soothing Bath Techniques

Anal fissures have been treated for a long time with steroid-containing hemorrhoid ointments?

Hello, Doctor Mu: I underwent surgery for an anal fistula due to hemorrhoids, but the healing has not been satisfactory.
I have been using a steroid-containing hemorrhoid cream for nearly five months, which has made the skin around my anus very fragile and prone to frequent cracking.
My follow-up doctor advised me to stop using any medication, but it has now been four and a half months, and the cracks around my anus have still not healed.
I would like to know if it is safe to take warm water sitz baths; I do this twice a day for 20 minutes each time.
Additionally, this condition is causing me a lot of pain, and I am unsure when I will recover.
Are there any other treatment options available? Thank you.

Xiao Lu, 40~49 year old female. Ask Date: 2018/07/20

Dr. Ke Fangxu reply Surgery

Long-term use of steroid ointments can lead to such side effects.
In addition to discontinuing the use of these ointments, warm water sitz baths can be a good maintenance method.
However, this may potentially make the already fragile skin even drier.
It is recommended to apply zinc oxide or petroleum jelly ointment after the warm water sitz bath to protect the skin.
At this point, one can only wait for the skin to gradually heal on its own.

Reply Date: 2018/07/20

More Info

Managing anal fissures can be a challenging and painful experience, especially after undergoing surgery for conditions like hemorrhoids or fistulas. Anal fissures are small tears in the lining of the anus, often caused by trauma, constipation, or prolonged diarrhea. They can lead to significant discomfort, pain during bowel movements, and sometimes bleeding. Given your situation, it’s essential to adopt a comprehensive approach to treatment and care.

Warm Water Sitz Baths
One of the most effective and soothing methods for managing anal fissures is the use of warm water sitz baths. You mentioned that you are already practicing this technique, which is excellent. Sitz baths can help relax the anal sphincter, increase blood flow to the area, and promote healing. Here are some guidelines for effective sitz baths:
1. Frequency: Continue with your routine of taking sitz baths twice a day, ideally after bowel movements. This can help cleanse the area and reduce discomfort.

2. Duration: Aim for about 15 to 20 minutes per session. This duration is sufficient to provide relief and promote relaxation of the anal muscles.

3. Temperature: Ensure the water is warm but not scalding. The warmth should be comfortable enough to help soothe the area without causing burns.

4. Additives: Some people find relief by adding Epsom salts or baking soda to the bath, which can help with inflammation and promote healing. However, consult your physician before adding any substances to ensure they are safe for your condition.

Topical Treatments
While your doctor has advised against using any topical medications, it’s crucial to discuss this further if your condition does not improve. Some options that may be considered include:
- Topical Nitroglycerin: This can help relax the anal sphincter and increase blood flow to the fissure, promoting healing.

- Calcium Channel Blockers: These can also be applied topically to help relax the sphincter muscle.

- Hydrocortisone Cream: If inflammation is significant, a mild topical steroid may be beneficial, but this should be used under medical supervision.

Dietary Considerations
Diet plays a crucial role in managing anal fissures. A diet high in fiber can help prevent constipation and reduce straining during bowel movements. Here are some dietary tips:
1. Increase Fiber Intake: Aim for 25-30 grams of fiber daily through fruits, vegetables, whole grains, and legumes.

2. Stay Hydrated: Drink plenty of water throughout the day to help soften stools.

3. Avoid Irritants: Limit spicy foods, caffeine, and alcohol, which can irritate the digestive tract and exacerbate symptoms.

Pain Management
Managing pain is essential for your comfort and can help you relax, which may facilitate healing. Over-the-counter pain relievers like acetaminophen or ibuprofen can be helpful. However, consult your physician before taking any medication, especially if you have other health conditions or are on other medications.

When to Seek Further Medical Attention
If your fissures do not improve with these measures, or if you experience severe pain, persistent bleeding, or signs of infection (such as increased redness, swelling, or discharge), it is crucial to return to your healthcare provider. In some cases, surgical options may be necessary to promote healing, especially if conservative measures fail.

Conclusion
In summary, managing anal fissures requires a multifaceted approach that includes warm sitz baths, dietary changes, and possibly topical treatments. It’s essential to maintain open communication with your healthcare provider about your symptoms and treatment options. Healing can take time, but with consistent care and attention, you can improve your condition and alleviate discomfort.

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