Chronic Anal Fissures: Pain Management and Treatment Options

Anal fissure pain, chronic anal fissure?

Hello Doctor: I have a problem with chronic anal fissures.
After seeing a doctor and adjusting my diet on December 25th last year, I have not experienced any bleeding.
However, sometimes when my stools are too hard, the wound still causes pain.
I have a few questions:
1.
Although my bowel movements are generally normal, the pain from the wound can still occur when my stools are too hard, but it does not reach the point of bleeding.
Could this lead to other more serious issues? I am always worried about developing a fistula...
It doesn't significantly affect my daily life, but it does cause me a lot of mental stress!
2.
Initially, the chronic fissure was on the left side, but recently a small new wound has appeared on the right side that I can feel with my fingers, although it is not bleeding.
After seeing a doctor, I was told that chronic fissures can reopen, and as long as I apply ointment for care, it should be fine.
However, I am concerned because it is on a different side, and I wonder how a new fissure could appear.
Will this new fissure heal, or will it become another chronic anal fissure?
3.
Could the repeated application of ointment on my chronic fissure make it worse? Or if there is no bleeding, should I stop applying the ointment?

Liu Xiaojie, 20~29 year old female. Ask Date: 2020/06/27

Dr. Ke Fangxu reply Surgery

1.
Anal fissures and fistulas are two different conditions; however, a small number of chronic anal fissures can lead to the formation of a subcutaneous fistula, which is different from a typical fistula.

2.
Anal fissures usually occur symmetrically, so it is possible for them to recur on the opposite side.

3.
If chronic anal fissures do not heal, surgical intervention may be necessary.
When there is no bleeding or pain, it is certainly acceptable to refrain from applying medication.

Reply Date: 2020/06/27

More Info

Chronic anal fissures can be a persistent and painful condition that significantly impacts a person's quality of life. Understanding the management and treatment options available is crucial for alleviating discomfort and promoting healing. Here are responses to your questions based on medical knowledge and practice.

1. Impact of Hard Stools on Chronic Anal Fissures: It is common for individuals with chronic anal fissures to experience pain when passing hard stools. While this pain may not always result in bleeding, it can exacerbate the fissure and potentially lead to further complications, such as the development of a fistula (an abnormal connection between the anal canal and the skin). The key to preventing worsening of the fissure is to maintain soft stools through dietary modifications, adequate hydration, and possibly the use of stool softeners or fiber supplements. If you consistently experience pain, it is advisable to consult with your healthcare provider to discuss your bowel habits and explore additional management strategies.

2. New Fissure Development: The appearance of a new fissure on the opposite side of the original chronic fissure can occur, especially if the underlying causes (such as constipation or straining during bowel movements) persist. Chronic fissures can lead to a cycle of pain and further tearing if not adequately managed. The new fissure may heal with proper care, including the application of topical medications and maintaining soft stools. However, if the fissure does not improve or worsens, it is essential to follow up with your healthcare provider for further evaluation and management. They may recommend additional treatments, such as topical nitroglycerin or calcium channel blockers, which can help relax the anal sphincter and promote healing.

3. Topical Treatments and Their Effects: Regular application of topical medications, such as ointments or creams, is generally beneficial for managing chronic anal fissures. These treatments can help reduce pain, promote healing, and prevent further irritation. However, overuse or inappropriate application may lead to skin irritation or worsening of the condition. If you are not experiencing bleeding and the fissure appears stable, you may not need to apply medication as frequently. It is essential to follow your healthcare provider's recommendations regarding the use of topical treatments and to monitor your symptoms closely.

In summary, managing chronic anal fissures involves a multifaceted approach that includes dietary changes, proper hydration, and the use of topical treatments. Regular follow-up with your healthcare provider is crucial to monitor the condition and adjust treatment as necessary. If you experience any concerning symptoms, such as increased pain, bleeding, or changes in bowel habits, do not hesitate to seek medical advice. Your mental well-being is also important; addressing the psychological stress associated with chronic pain can be beneficial, so consider discussing this aspect with your healthcare provider as well.

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