Chronic Anal Fissure: Seeking Solutions for Persistent Pain and Discomfort

The anal fissure has persisted for over a month without improvement?

Hello Doctor, I experienced a mild anal fissure due to bowel movements in early August.
After a few days, thinking I had recovered, I engaged in anal intercourse.
Since then, my fissure has not healed.
Initially, I didn't pay much attention and bought over-the-counter ointments for anal fissures, but they did not improve my condition; in fact, it worsened.
Later, I visited a doctor at Mackay Memorial Hospital in Hsinchu, who diagnosed me with an anal fissure without performing a digital examination.
The doctor only examined the surface of the anus and prescribed painkillers, stool softeners, and topical medications.
However, the topical medication seemed to irritate the wound further, and I later developed purulent discharge.
I then consulted a doctor at National Taiwan University Hospital, who performed a digital examination and found inflammation of the anal mucosa (I wonder if this is related to my habit of washing my anus with water), which may have contributed to the purulent discharge.
I was prescribed anti-inflammatory painkillers, antacids, and diluted povidone-iodine sitz baths.
It has now been over a month, and the pain has only slightly improved.
I still wake up at night due to pain, and when I have a bowel movement in the morning, it feels like the wound reopens, causing pain throughout the day.
The discharge has not decreased, indirectly affecting my daily life.
Additionally, I have been experiencing body heat and weakness every evening, along with recent episodes of heart palpitations and headaches.
Should I wait until I finish this course of medication before returning for a follow-up, or should I go back earlier? However, returning for a follow-up would require me to have my anus dilated (which might cause it to reopen again).
I am very concerned about my condition and would greatly appreciate your professional advice.

Xiao Xuan, 20~29 year old female. Ask Date: 2018/09/15

Dr. Ke Fangxu reply Surgery

The inflammation of the anal mucosa is not related to washing the buttocks with water unless water is being forced into the rectum, which is a very dangerous practice and should never be done.
If there are anal fissures, it is essential to avoid constipation and diarrhea, as well as anal intercourse.
If not properly treated, there is a risk of bacterial infection and even the development of an anal abscess.
It is recommended to enhance sitz baths and to schedule a follow-up appointment as soon as possible to prevent the condition from worsening.

Reply Date: 2018/09/15

More Info

Chronic anal fissures can be a source of significant discomfort and distress, as you've described. It’s understandable that you are seeking effective solutions for your persistent pain and discomfort. Anal fissures are small tears in the lining of the anus, often caused by trauma during bowel movements, and they can become chronic if not treated properly.

From your account, it appears that your initial fissure was exacerbated by anal intercourse, which is a common issue as it can introduce additional trauma to an already sensitive area. The treatment you've received so far, including topical medications and pain relief, is a standard approach, but it seems that your condition has not improved significantly, leading to further complications such as inflammation and discharge.

Here are some recommendations based on your situation:
1. Follow-Up with Your Doctor: Given that you have been experiencing ongoing pain, discharge, and other systemic symptoms like fever and fatigue, it is crucial to follow up with your healthcare provider sooner rather than later. These symptoms could indicate an infection or another underlying issue that requires immediate attention. It’s understandable to be apprehensive about further examinations, but your health is paramount.

2. Pain Management: If the pain is severe enough to wake you at night, you may need to discuss stronger pain management options with your doctor. This could include prescription pain medications or topical anesthetics that can provide temporary relief.

3. Dietary Adjustments: Ensuring that your bowel movements are soft and regular is essential. A high-fiber diet, along with adequate hydration, can help prevent straining during bowel movements, which is critical for healing. Consider incorporating more fruits, vegetables, whole grains, and possibly a fiber supplement if necessary.

4. Sitz Baths: You mentioned using diluted iodine for sitz baths, which can be soothing. Regular sitz baths in warm water can help relax the anal sphincter and promote healing. Aim for 15-20 minutes several times a day, especially after bowel movements.

5. Avoid Irritants: If you have been using topical medications that irritate the area, it may be worth discussing alternative treatments with your doctor. Sometimes, less is more, and allowing the area to heal without additional irritation can be beneficial.

6. Consider Other Treatments: If conservative measures fail, there are other treatment options available for chronic anal fissures. These can include:
- Botulinum toxin injections: This can help relax the anal sphincter and promote healing.

- Lateral internal sphincterotomy: A surgical procedure that can relieve pressure and promote healing in chronic fissures.

- Topical nitrates or calcium channel blockers: These can help increase blood flow to the area and promote healing.

7. Monitor Systemic Symptoms: The systemic symptoms you mentioned, such as body heat and fatigue, could be related to an infection or another medical condition. It’s important to communicate these symptoms to your healthcare provider, as they may require further investigation.

In summary, while it is understandable to be cautious about further examinations, it is essential to prioritize your health and seek timely medical advice. Chronic anal fissures can lead to complications if not addressed properly, and your symptoms warrant a thorough evaluation. Don’t hesitate to reach out to your healthcare provider for guidance on the best course of action. Your well-being is the most important consideration, and there are effective treatments available to help you find relief.

Similar Q&A

Understanding Chronic Anal Fissures: Pain Management and Healing Options

For the past two months, I have experienced pain every time I use the restroom. I have tried soaking in warm water and using topical ointments and suppositories, and I have been mindful of my diet, with no issues of constipation. I typically go to the bathroom about 2 to 3 times ...

Dr. Ke Fangxu reply Surgery
The typical symptoms of an anal fissure include pain during bowel movements accompanied by slight bleeding. The pain can persist for several days, sometimes exceeding a week. The common causes are often constipation or diarrhea. The fundamental treatment is to address the bowel m...

Chronic Anal Discomfort: Understanding Fissures and Treatment Options

Hello Doctor, I have been experiencing recurrent anal fissures for the past five years. Initially, it was caused by hard stools, and typically after applying medication for 5-6 days, I would see improvement. However, once I stop the medication, I start to experience swelling and ...

Dr. Ke Fangxu reply Surgery
The typical symptoms of anal fissures include pain during bowel movements accompanied by slight bleeding. The common causes are often constipation or diarrhea. The fundamental treatment is to improve bowel habits, along with warm sitz baths. Warm sitz baths can help alleviate pai...

Chronic Anal Fissures: Impact on Bowel Health and Healing

1. Based on your description, it sounds like you may be experiencing chronic anal fissures. Chronic anal fissures are defined as fissures that persist for more than eight weeks and can cause recurring pain and discomfort. 2. If the fissures have not healed over time, they can le...

Dr. Zhang Shuhao reply Surgery
Acute anal fissures typically heal within about a week if the wound is allowed to rest properly. However, if the affected area is repeatedly injured and symptoms persist for more than six weeks, it is classified as a chronic anal fissure. This may be due to tight anal sphincter m...

Chronic Anal Fissures: Surgical Options for Lasting Relief

Hello Doctor, my condition has persisted for 6 months. Symptoms include anal itching, a sensation of fissures inside the anus, and I can feel polyps on the inner wall when I insert my finger. A previous doctor diagnosed me with anal fissures and internal hemorrhoids. It is very p...

Dr. Xu Kaixi reply Surgery
Based on your description, this is an internal hemorrhoid combined with anal fissure, which has recurrent flare-ups and healing, making it difficult to fully recover. It is recommended that you identify contributing factors such as constipation and irregular bowel habits that may...