Anal Issues: Fissures, Hemorrhoids, and Treatment Options

Anal issues

Hello, Dr.
Ko: Last month, I visited a doctor due to anal pain and rectal bleeding.
At that time, the doctor diagnosed me with anal fissures and internal hemorrhoids.
1.
I later noticed a long lump between my anus and perineum that feels soft and is not very painful when pressed.
Could this be an anal fistula or something like a sentinel hemorrhoid? 2.
Can anal fissures lead to infections that cause abscesses or fistulas? 3.
I usually have hard stools for the first bowel movement, but the rest are smooth.
I eat a lot of fruits and vegetables, but the hardness of the first stool causes my anal fissures to recur.
Is there a reason for this or any ways to improve it? I apologize for the many questions, and thank you, doctor.

Niming, 20~29 year old female. Ask Date: 2019/04/04

Dr. Ke Fangxu reply Surgery

1.
If the anal fissure is located in the anterior region, it is indeed possible for inflammation to cause this phenomenon; however, anal fistulas are generally not the case, but a physician should be consulted for a definitive diagnosis.
2.
The progression of chronic anal fissures to fistulas is not uncommon, but the development of an anal abscess is relatively rare.
3.
The issue of constipation is a common topic; aside from increasing dietary fiber intake, drinking water, and exercising, there are no other effective methods.
If dietary and lifestyle changes do not improve the situation, it may be necessary to use stool softeners to prevent symptom exacerbation.

Reply Date: 2019/04/04

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your anal issues, specifically concerning fissures, hemorrhoids, and the potential for other complications. I appreciate your openness in sharing your symptoms and concerns, and I will address each of your questions thoroughly.

1. Regarding the lump between the anus and perineum: The soft lump you described could potentially be a number of things, including a sentinel pile (a type of hemorrhoid) or possibly an anal fistula. A sentinel pile often develops as a result of chronic anal fissures and can appear as a soft, painless lump. An anal fistula, on the other hand, is an abnormal connection between the anal canal and the skin, which can occur due to an infection or abscess. It is important to have this evaluated by a healthcare professional, as they can perform a physical examination and possibly imaging studies to determine the exact nature of the lump.

2. Can anal fissures lead to infections, abscesses, or fistulas? Yes, anal fissures can indeed lead to complications such as infections or abscesses. When a fissure is present, it can create a pathway for bacteria to enter the deeper tissues, potentially leading to an abscess. If an abscess forms and is not adequately treated, it can develop into a fistula. This is why it is crucial to manage fissures effectively and seek treatment if you notice any signs of infection, such as increased pain, swelling, or discharge.

3. Regarding the hard stool and recurrent fissures: It is common for individuals to experience hard stools, especially if they are not adequately hydrated or if their diet lacks sufficient fiber. Even if you consume a lot of fruits and vegetables, other factors such as fluid intake and overall digestive health can influence stool consistency. To prevent hard stools and reduce the risk of fissures, consider the following strategies:
- Increase water intake: Aim for at least 8-10 glasses of water a day, as hydration is key to softening stools.

- Fiber supplements: If dietary fiber is insufficient, consider using fiber supplements like psyllium husk or methylcellulose to help bulk up and soften stools.

- Regular bowel habits: Try to establish a routine for bowel movements, and avoid straining during defecation.

- Stool softeners: Over-the-counter stool softeners can be helpful in easing the passage of stool.

- Warm baths: Soaking in warm water can help soothe the anal area and promote relaxation, which may assist in bowel movements.

In conclusion, it is essential to consult with your healthcare provider regarding the lump you have noticed and to discuss your ongoing issues with anal fissures. They may recommend treatments such as topical medications, dietary changes, or even surgical options if necessary. Regular follow-ups can help monitor your condition and prevent complications.

Please do not hesitate to reach out if you have further questions or need additional clarification. Your health and comfort are important, and I wish you the best in your recovery.

Sincerely,
Doctor Q&A Teams

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