Anal Fissures: Causes, Symptoms, and Healing Time

Anal fissure

Hello, in February, I noticed some red spots in my stool on two occasions.
In April and May, there was one instance each month as well.
However, I may have consumed some red foods like tomatoes or strawberries before that.
The fecal occult blood test was negative.
After a digital rectal exam in February, I began to experience discomfort in the anal area and a sensation of urgency.
By June, I developed anal fissures, and I experienced bleeding from the anus for several consecutive days.
The doctor diagnosed me with anal fissures, but I still have the sensation of urgency.
I have not undergone a colonoscopy yet.
How long does it typically take for anal fissures to heal? I maintain a regular lifestyle, do not often eat out, and consume a large amount of fruits and vegetables daily.
Is it possible that the digital rectal exam caused the anal fissures?

Cc, 30~39 year old female. Ask Date: 2020/06/24

Dr. Ke Fangxu reply Surgery

It is impossible for a finger examination to cause an anal fissure because feces are several times thicker than a finger.
The typical causes are often constipation or diarrhea.
The classic symptoms include pain during bowel movements accompanied by slight bleeding.
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 used.
If symptoms persist without improvement, it is advisable to consult a physician for further evaluation.

Reply Date: 2020/06/24

More Info

Anal fissures are small tears in the lining of the anus, often resulting from trauma during bowel movements, particularly when passing hard or large stools. They can cause significant discomfort, including sharp pain during and after bowel movements, and may lead to bleeding, which can be alarming. Understanding the causes, symptoms, and healing time for anal fissures is essential for effective management and recovery.

Causes of Anal Fissures
1. Trauma: The most common cause of anal fissures is trauma to the anal canal, typically from passing hard or large stools. This can occur due to constipation or straining during bowel movements.

2. Chronic Diarrhea: Frequent loose stools can also irritate the anal area, leading to fissures.

3. Childbirth: Women may experience anal fissures during childbirth due to the pressure and stretching of the anal area.

4. Inflammatory Conditions: Conditions such as Crohn's disease or ulcerative colitis can lead to fissures due to inflammation in the gastrointestinal tract.

5. Anal Intercourse: This can also cause trauma to the anal area, leading to fissures.

6. Medical Procedures: As you mentioned, a digital rectal exam (DRE) can sometimes cause trauma to the anal canal, especially if not performed gently.

Symptoms of Anal Fissures
- Pain: Sharp pain during and after bowel movements is the hallmark symptom of anal fissures. This pain can be severe and may last for several hours.

- Bleeding: Bright red blood may be seen on the toilet paper or in the stool.

- Itching or Irritation: The area around the anus may feel itchy or irritated.

- Spasms: Some individuals may experience spasms of the anal sphincter, which can exacerbate pain and discomfort.

Healing Time
The healing time for anal fissures can vary significantly based on several factors, including the severity of the fissure and the treatment approach. Generally, acute fissures (those present for less than six weeks) can heal within a few weeks with appropriate management. Chronic fissures (those lasting longer than six weeks) may take longer to heal and may require more intensive treatment.

Management and Treatment
1. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements. Staying hydrated is also crucial.

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

3. Topical Treatments: Over-the-counter creams containing hydrocortisone or prescription medications like nitroglycerin ointment can help relax the anal sphincter and promote healing.

4. Medications: Stool softeners or laxatives may be recommended to prevent constipation and reduce straining.

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

Conclusion
Given your symptoms and the timeline of events, it is possible that the digital rectal exam may have contributed to the development of your anal fissure, especially if there was any trauma during the procedure. However, it is essential to address the underlying issues, such as bowel habits and stool consistency, to facilitate healing.

If your symptoms persist or worsen, or if you experience significant pain or bleeding, it is crucial to consult with a healthcare provider for further evaluation and management. A colonoscopy may also be warranted to rule out other underlying conditions, especially if there are concerns about the nature of the bleeding or if symptoms do not improve with conservative measures.

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