Anoscopy and Anal Fissures: Causes, Symptoms, and Treatments

Anoscopy and Anal Fissure Issues

Hello doctor, last Thursday I noticed bright red blood when wiping after a bowel movement, so I went to Hsinchu Mackay Memorial Hospital for an examination the next day.
The physician performed a rectal examination and diagnosed me with a grade I hemorrhoid and anal fissure.
He believed that the bleeding was due to the fissure rather than the hemorrhoid and prescribed me a suppository (Yizhi Kang).
He mentioned that if there is bleeding, it should be addressed.
I have not experienced constipation and have been having normal bowel movements, with the only bleeding occurring last Thursday.
Since then, everything has been normal, but after the examination, I occasionally feel slight pain and a sensation of warmth in the anal area.
I would like to know if this could be caused by the rectal examination or if it is related to the fissure.
Since there has been no bleeding, can it be concluded that the fissure has healed? Additionally, I noticed that the medication prescribed by the doctor seems to be used for treating hemorrhoids; can this medication also be used to treat anal fissures?

Kevin, 20~29 year old female. Ask Date: 2019/12/10

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.
Topical medications are generally the same as those used for hemorrhoids, and their effects include pain relief, astringent properties, and hemostasis.
You can use them with confidence.
If the symptoms resolve after treatment, it can be considered healed.

Reply Date: 2019/12/10

More Info

Anoscopy is a medical procedure that allows healthcare providers to examine the anal canal and lower rectum using a specialized instrument called an anoscope. This procedure is particularly useful for diagnosing conditions related to the anal area, such as hemorrhoids, anal fissures, and other abnormalities. In your case, the examination revealed a first-degree hemorrhoid and an anal fissure, which are common conditions that can cause rectal bleeding and discomfort.

Causes of Anal Fissures
Anal fissures are small tears in the lining of the anus, often caused by trauma during bowel movements. Common causes include:
1. Straining during bowel movements: This can occur due to constipation or hard stools.

2. Diarrhea: Frequent loose stools can irritate the anal area.

3. Childbirth: Women may experience fissures during or after delivery.

4. Anal intercourse: This can also lead to tearing of the anal tissue.

Symptoms of Anal Fissures
The primary symptoms of anal fissures include:
- Sharp pain during bowel movements: This is often described as a "tearing" sensation.

- Bright red blood on toilet paper or in the stool: This is a common sign of bleeding associated with fissures.

- Itching or irritation around the anus: This may occur due to inflammation.

- A visible tear or crack in the skin: This can sometimes be seen during a physical examination.

Treatment Options
The treatment for anal fissures typically focuses on relieving pain, promoting healing, and preventing recurrence. Here are some common approaches:
1. Topical medications: Your doctor prescribed a suppository (益痔康), which is often used to treat hemorrhoids but can also help with fissures by reducing inflammation and promoting healing. These medications may contain ingredients that soothe the area and reduce pain.

2. Dietary changes: Increasing fiber intake can help soften stools, making bowel movements easier and reducing strain. Staying hydrated is also crucial.

3. Sitz baths: Soaking the anal area in warm water for 10-15 minutes several times a day can help relieve pain and promote healing.

4. Pain relief: Over-the-counter pain relievers can help manage discomfort during the healing process.

5. Surgical options: If conservative treatments fail and the fissure persists, surgical options may be considered, such as lateral internal sphincterotomy, which involves cutting a small portion of the anal sphincter muscle to relieve tension and promote healing.

Your Concerns
Regarding your specific concerns, it is possible that the mild pain and sensation of heat you are experiencing could be related to the anal fissure itself rather than the anoscopy procedure. Anoscopy can cause temporary discomfort, but it should not lead to significant pain or prolonged symptoms. If you are not experiencing any further bleeding, it may indicate that the fissure is healing, but it is essential to monitor your symptoms closely.

As for the medications prescribed, while they are primarily aimed at treating hemorrhoids, they can also be effective for anal fissures. However, it is always best to follow up with your healthcare provider if you have concerns about the appropriateness of the treatment for your specific condition.

Conclusion
In summary, anal fissures are a common condition that can cause significant discomfort but are usually manageable with conservative treatment. It is essential to maintain a healthy diet, follow your doctor's recommendations, and monitor your symptoms. If you experience worsening pain, persistent symptoms, or any new concerns, do not hesitate to reach out to your healthcare provider for further evaluation and management.

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