Anal Fissures: Treatment Options and Recovery Insights

Q: Anal Fissures: Treatment Options and Recovery Insights

Answer： Hemorrhoid ointments do contain steroids, but they do not make it easier to develop anal fissures. <br>Recovery after surgery typically takes about 2-4 weeks, and complications such as anal incontinence are unlikely to occur. <br>Chronic anal fissures can be treated using

Anal fissure issues?

I started experiencing symptoms of anal fissures two to three years ago.
Previously, my stools were quite hard, and after a few episodes of fissures, I realized that if my stool was even slightly hard, it could lead to tearing.
I later began taking probiotics and traditional Chinese medicine to soften my stools.
However, as my stools became softer, my anal opening also became smaller.
Now, I can only tolerate a very low thickness of stool; anything thicker than the diameter of a five-dollar coin will likely cause a noticeable tear.
I have tried inserting my finger, but it feels very tight and painful.
I have seen a colorectal specialist, who only prescribed topical ointments or suppositories.
I have now developed chronic anal fissures, and occasionally, if my stool is a bit harder or thicker, it may tear.
After bowel movements, I wash my buttocks with warm water, and if there are any wounds, I apply a bit of hemorrhoid ointment.
I usually experience more pain from the fissures right after using the restroom, but it gets better afterward.

I would like to ask the doctor if using hemorrhoid ointment for a long time will make anal fissures more likely, especially since it contains steroids.
If I opt for surgical treatment, how long will recovery take? Is there a risk of complications, such as anal incontinence? Are there any other methods available, such as anal dilation?

Cheng Cheng, 30~39 year old female. Ask Date: 2019/07/11

Dr. Ke Fangxu reply Surgery

Answer: Hemorrhoid ointments do contain steroids, but they do not make it easier to develop anal fissures.
Recovery after surgery typically takes about 2-4 weeks, and complications such as anal incontinence are unlikely to occur.
Chronic anal fissures can be treated using self-dilation methods, although this approach is generally ineffective and can be quite painful.
If one is willing, it may be worth trying.

Reply Date: 2019/07/11

More Info

Anal fissures are small tears in the lining of the anal canal, often resulting from the passage of hard or large stools. They can cause significant pain and discomfort, especially during bowel movements. Your experience with chronic anal fissures is not uncommon, and it’s important to address both the symptoms and the underlying causes to promote healing and prevent recurrence.

Treatment Options
1. Dietary Modifications: One of the most effective ways to manage and prevent anal fissures is by ensuring that your stools remain soft. This can be achieved by increasing your fiber intake through fruits, vegetables, whole grains, and legumes. Additionally, staying well-hydrated by drinking plenty of water can help soften stools.

2. Medications: Topical treatments, such as nitroglycerin ointment or calcium channel blockers (like diltiazem), can help relax the anal sphincter and increase blood flow to the area, promoting healing. While you mentioned using hemorrhoid creams, it’s essential to ensure that they do not contain steroids, as prolonged use of steroid-containing creams can lead to skin thinning and may worsen fissures.

3. Sitz Baths: Taking warm sitz baths several times a day, especially after bowel movements, can help soothe the area, reduce pain, and promote healing. The warmth increases blood flow to the area, which can aid in recovery.

4. Laxatives and Stool Softeners: If dietary changes alone are insufficient, consider using over-the-counter stool softeners or mild laxatives to ensure that bowel movements are less painful.

5. Botulinum Toxin Injections: In cases where conservative treatments fail, botulinum toxin (Botox) can be injected into the anal sphincter to temporarily paralyze the muscle, reducing spasm and pain, allowing the fissure to heal.

6. Surgery: If conservative treatments do not provide relief, surgical options may be considered. The most common procedure is lateral internal sphincterotomy, which involves cutting a small portion of the anal sphincter muscle to relieve tension and pain. Recovery from this surgery typically takes a few weeks, and while complications are rare, they can include incontinence or changes in bowel control.

Recovery Insights
Recovery from anal fissures can vary based on the severity of the fissure and the treatment approach. With proper management, many individuals experience significant improvement within a few weeks. However, chronic fissures may take longer to heal, and ongoing management may be necessary to prevent recurrence.

Potential Complications
While surgery can be effective, it’s important to discuss potential risks with your healthcare provider. Concerns about anal incontinence or changes in bowel control are valid, but these complications are relatively rare when the procedure is performed by an experienced surgeon.

Additional Considerations
- Avoiding Strain: It’s crucial to avoid straining during bowel movements, as this can exacerbate fissures. If you feel the urge to go, try to respond promptly rather than delaying, which can lead to harder stools.

- Relaxation Techniques: Stress can impact bowel habits and exacerbate symptoms. Techniques such as mindfulness, yoga, or other relaxation methods may help reduce stress and improve overall bowel health.

- Follow-Up Care: Regular follow-ups with your healthcare provider can help monitor your condition and adjust treatment as necessary.

In summary, managing chronic anal fissures involves a combination of dietary changes, topical treatments, and possibly surgical options if conservative measures fail. It’s essential to work closely with a healthcare provider to develop a personalized treatment plan that addresses your specific needs and concerns.

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