Chronic Anal Fissures: Causes, Symptoms, and Treatment

Anal fissure issues?

Hello doctor, I have been dealing with anal fissures for a year now.
During my intermittent visits to the clinic, the doctors have consistently diagnosed it as anal fissures.
In February of this year, I underwent a colonoscopy which diagnosed me with nonspecific colitis, but later the doctor said I had healed.
I thought I was fine, but I still occasionally experience rectal bleeding.
Initially, I would return for follow-ups, but each time they said it was just the fissures and that the wounds were nearly healed.
However, I find myself bleeding once or twice a week.
After healing, if I have a harder stool on any given day, it will split again, and this cycle keeps repeating.
Recently, the pain after bowel movements has been severe—it's so intense that only soft stools from diarrhea don't cause pain.
Is this considered "chronic" anal fissures? Is it normal for them to keep recurring?

Kunrao Yijiu de Ren, 20~29 year old female. Ask Date: 2019/12/30

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 related to constipation or diarrhea, and recurrent episodes are a frequent occurrence.
The fundamental treatment is to improve bowel habits, along with warm sitz baths.
Warm sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
Over-the-counter hemorrhoid suppositories can also be purchased for use.
If symptoms persist without improvement, it is advisable to consult a physician.
Surgical treatment may also be considered if necessary.

Reply Date: 2019/12/30

More Info

Chronic anal fissures are a common condition that can cause significant discomfort and distress. They are defined as tears in the lining of the anal canal that persist for more than eight weeks. Understanding the causes, symptoms, and treatment options for chronic anal fissures is crucial for effective management and relief.

Causes of Chronic Anal Fissures
Chronic anal fissures often arise from trauma to the anal canal, which can be caused by:
1. Hard Stools: Straining during bowel movements due to constipation can lead to tears in the anal lining.

2. Diarrhea: Frequent loose stools can also irritate the anal area and contribute to fissure formation.

3. Anal Intercourse: This can cause trauma to the anal canal, leading to fissures.

4. Inflammatory Conditions: Conditions like inflammatory bowel disease (IBD) or other gastrointestinal disorders can predispose individuals to fissures.

5. Poor Blood Supply: The anal area has a limited blood supply, which can impair healing and contribute to chronicity.

Symptoms of Chronic Anal Fissures
The primary symptoms of chronic anal fissures include:
- Pain: Severe pain during and after bowel movements is a hallmark symptom. Patients often describe the pain as sharp or burning, which can last for hours.

- Bleeding: Bright red blood may be seen on the toilet paper or in the toilet bowl after a bowel movement.

- Itching or Irritation: The area around the fissure may become itchy or irritated.

- Visible Tear: A fissure may be visible as a small tear or cut in the skin around the anus.

Treatment Options
Managing chronic anal fissures typically involves a combination of lifestyle modifications, topical treatments, and, in some cases, surgical interventions. Here are some common approaches:
1. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements. Drinking plenty of water is also essential.

2. Stool Softeners: Over-the-counter stool softeners can help ease bowel movements and prevent further trauma to the anal area.

3. Topical Treatments:
- Nitroglycerin Ointment: This can help relax the anal sphincter and increase blood flow to the area, promoting healing.

- Calcium Channel Blockers: Topical medications like diltiazem can also be effective in reducing sphincter pressure and promoting healing.

- Corticosteroid Creams: These can help reduce inflammation and itching.

4. Sitz Baths: Soaking in warm water several times a day can help soothe the area and promote healing.

5. Botulinum Toxin Injections: In some cases, injecting botulinum toxin into the anal sphincter can help reduce muscle tension and promote healing.

6. Surgery: If conservative treatments fail, surgical options such as lateral internal sphincterotomy may be considered. This procedure involves cutting a small portion of the anal sphincter muscle to relieve tension and promote healing.

Conclusion
Chronic anal fissures can be a frustrating and painful condition, especially when they recur frequently. It is important to work closely with a healthcare provider to develop a comprehensive treatment plan tailored to your specific situation. If you are experiencing persistent symptoms, it may be beneficial to seek a referral to a specialist, such as a gastroenterologist or a colorectal surgeon, for further evaluation and management.

In your case, given the history of recurrent bleeding and pain, it is essential to ensure that there are no underlying conditions contributing to your symptoms. Regular follow-up and adherence to treatment recommendations can significantly improve your quality of life and help manage this condition effectively.

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