Anal Fissures: Causes, Symptoms, and Treatment Options

Anal fissure - burning sensation in the buttocks?

Hello Doctor: Since March 17, I have been experiencing bleeding when using the restroom, along with swelling and pain in the anal area, and I noticed some protrusions.
I visited Mackay Memorial Hospital, where the doctor performed an anoscopy and diagnosed me with an anal fissure.
I asked the doctor if I had hemorrhoids, and he said there was a small external hemorrhoid.
I inquired if it could be removed, but the doctor said it was unnecessary and that my pain was due to the anal fissure.
He prescribed me with a topical ointment (Yizhi Kang) and suppositories, along with Lema fiber supplement.
I continued taking the medication and performed warm sitz baths daily, and while the swelling in the anal area initially subsided, starting from March 23, I began to feel a persistent burning sensation in the left side of my buttocks, as if there was fire burning inside.
Sitting on hard chairs caused some discomfort, but pressing on my buttocks did not cause pain, which worried me.
Therefore, on March 29, I visited a clinic near my home.
The doctor examined me and also diagnosed an anal fissure (he saw the bleeding in the photos) and two internal and external hemorrhoids.
When I asked about the burning sensation, the doctor mentioned it could be due to muscle strain or that some individuals who are underweight may feel discomfort in that area due to lack of cushioning.
He prescribed pain relief and anti-inflammatory medication for the anal fissure, along with Liyu hemorrhoid ointment and suppositories.
After a week of medication, I no longer experienced bleeding during bowel movements, but the burning sensation in my buttocks has not resolved (it is persistent, not just after bowel movements).
I would like to ask the doctor: 1.
Since I am no longer bleeding, does this mean my anal fissure has healed? Should I continue using the suppositories and ointment? 2.
If it is an anal fissure, shouldn't the discomfort be primarily in the anal area rather than a burning sensation in the buttocks? What do you recommend I do? Should I continue to seek medical attention or just observe? 3.
Could the burning sensation be an adverse effect of the medication? Thank you.

Chen Ya Ya, 30~39 year old female. Ask Date: 2020/04/06

Dr. Ke Fangxu reply Surgery

1.
Although there is no longer any bleeding, if there is still pain, you may apply ointment again.

2.
The cause of anal fissures is often due to constipation or diarrhea.
The fundamental treatment is to improve bowel movements, along with warm sitz baths.
Warm sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
It is recommended to continue using the medications prescribed by the physician.
If symptoms persist without improvement, it is best to consult a doctor.

3.
It should not be.

Reply Date: 2020/04/06

More Info

Anal fissures are small tears in the lining of the anus, often causing significant discomfort and bleeding during bowel movements. They can be quite painful and are commonly associated with conditions such as constipation, diarrhea, or trauma to the anal area. Understanding the causes, symptoms, and treatment options for anal fissures can help manage the condition effectively.

Causes of Anal Fissures
Anal fissures can occur due to several reasons:
1. Constipation: Straining during bowel movements can lead to tears in the anal lining.

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

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

4. Anal Intercourse: This can also lead to trauma and subsequent fissures.

5. Underlying Conditions: Conditions like Crohn's disease or other inflammatory bowel diseases can contribute to the development of fissures.

Symptoms
The primary symptoms of anal fissures include:
- Sharp pain during and after bowel movements.

- Bleeding, which may be bright red and can be seen on the toilet paper or in the toilet bowl.

- A visible tear or crack in the skin around the anus.

- A burning sensation or discomfort in the anal area, which may persist even after bowel movements.

Treatment Options
Treatment for anal fissures typically focuses on relieving pain, promoting healing, and preventing recurrence. Here are some common approaches:
1. Topical Treatments: Medications such as nitroglycerin ointment, calcium channel blockers, or topical anesthetics can help relieve pain and promote healing.

2. Fiber Supplements: Increasing dietary fiber can help soften stools and reduce straining during bowel movements.

3. Sitz Baths: Soaking in warm water can help soothe the anal area and promote healing.

4. Medications: Over-the-counter pain relievers can help manage discomfort.

5. Surgery: In chronic cases where conservative treatments fail, surgical options such as lateral internal sphincterotomy may be considered to relieve tension in the anal sphincter.

Addressing Your Concerns
1. Healing Status: If you are no longer experiencing bleeding, it is a positive sign that your anal fissure may be healing. However, it is essential to continue using the prescribed medications and topical treatments as directed by your physician to ensure complete healing and prevent recurrence.

2. Burning Sensation: The burning sensation you are experiencing may not be typical for anal fissures, which usually present with sharp pain rather than a continuous burning feeling. This discomfort could be due to muscle strain, irritation from the fissure, or even the medications you are using. It is advisable to monitor this symptom closely.

3. Follow-Up Care: Given that you are still experiencing discomfort, it would be prudent to follow up with your healthcare provider. They can assess your condition further and determine if additional treatments or adjustments to your current regimen are necessary.

4. Medication Side Effects: Some topical treatments can cause localized irritation or a burning sensation. If you suspect that your medication might be contributing to your discomfort, discuss this with your doctor. They may suggest alternative treatments or adjust your current medications.

In conclusion, while it seems you are on the right path towards healing your anal fissure, ongoing symptoms warrant further evaluation. Maintaining open communication with your healthcare provider is crucial to ensure that you receive the most effective treatment for your condition.

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