Addressing Common Concerns in Anal Fissure Treatment - Surgery

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Addressing common concerns in anal fissure treatment involves understanding the underlying causes, effective management strategies, and when to seek further medical intervention. Anal fissures are small tears in the lining of the anus, often caused by trauma during bowel movements, particularly when passing hard stools. Your situation, where you experienced diarrhea followed by constipation, can indeed exacerbate fissures and lead to a cycle of pain and discomfort.


Understanding Anal Fissures
Anal fissures can be acute or chronic. Acute fissures are usually caused by trauma, such as passing hard stools or prolonged straining during bowel movements. Chronic fissures, on the other hand, may be associated with underlying conditions such as inflammatory bowel disease or anal sphincter dysfunction. Symptoms typically include sharp pain during and after bowel movements, bleeding, and sometimes a visible tear.


Treatment Strategies
1. Dietary Modifications: Increasing fiber intake is crucial. A diet rich in fruits, vegetables, and whole grains can help soften stools and promote regular bowel movements. Aim for at least 25-30 grams of fiber per day. Additionally, staying well-hydrated by drinking plenty of water is essential.

2. Medications: Over-the-counter stool softeners can be beneficial. These medications help to make bowel movements easier and less painful. If you are already using a stool softener and still experiencing difficulty, it may be worth discussing with your healthcare provider whether a different type or dosage might be more effective.

3. Topical Treatments: The use of topical anesthetics or nitroglycerin ointment can help relieve pain and promote healing. These medications work by relaxing the anal sphincter, which can reduce spasm and pain during bowel movements.

4. Sitz Baths: Warm sitz baths can provide relief by soothing the area and promoting blood flow, which aids in healing. It is recommended to soak in warm water for about 15-20 minutes several times a day, especially after bowel movements.

5. Avoid Straining: It is important to avoid straining during bowel movements, as this can worsen fissures. If you feel the urge to go but are unable to, try not to force it. Instead, consider using a footstool to elevate your feet while sitting on the toilet, which can help facilitate easier bowel movements.


Addressing Your Concerns
Regarding your question about whether the difficulty in passing stools could be due to hardened stool or "宿便" (stool that has remained in the intestines for too long), it is possible. If stool remains in the colon for an extended period, it can harden and become difficult to pass. This can lead to further straining and exacerbate fissures.

Using an enema can be a helpful option for relieving constipation, but it should be approached with caution. Frequent use of enemas can lead to dependency and may disrupt normal bowel function. It is advisable to consult with your healthcare provider before using an enema, especially considering your recent history of anal fissures.


When to Seek Further Medical Help
If your symptoms persist despite following these treatment strategies, or if you experience severe pain, significant bleeding, or signs of infection (such as fever or pus), it is crucial to seek medical attention. In some cases, surgical intervention may be necessary to address chronic fissures or underlying issues.

In summary, managing anal fissures involves a combination of dietary changes, medications, topical treatments, and lifestyle modifications. If you find that your symptoms are not improving, do not hesitate to reach out to your healthcare provider for further evaluation and tailored treatment options.