Managing Chronic Anal Fissures: Concerns, Treatments, and Next Steps

Chronic anal fissure

Hello Doctor: I have been suffering from chronic anal fissures due to frequent constipation for the past 2 to 3 years.
Initially, after controlling my diet last December, I stopped bleeding, but in the past two months, I experienced hard stools again, which caused a fissure.
Although it healed, I have started bleeding again recently due to slightly hard stools.
I have a few questions for you:
1.
Each time it heals, it lasts only a few months before I accidentally become constipated again and it reopens, but it heals again in a few days.
Could this lead to serious problems in the long run?
2.
I have seen many doctors, and they all say that since I am still young, they only recommend topical treatments and do not suggest surgery.
What is your opinion? Although anal fissures do not severely impact my daily life, they cause me significant psychological stress, as I constantly worry about constipation or bleeding when using the restroom.
I would like a permanent solution.

3.
Are the effects of anal suppositories and hemorrhoid ointments the same? I find that using suppositories makes my anal area uncomfortable.

4.
Since I have been experiencing recurrent bleeding, I am concerned that there might be an internal issue.
I have been considering getting a colonoscopy, but I am afraid that the laxatives will worsen my fissure.
Would you recommend that I get a colonoscopy now, or should I wait a few more years? Thank you for your response, Doctor.

Jun, 20~29 year old female. Ask Date: 2020/09/29

Dr. Ke Fangxu reply Surgery

1.
Chronic anal fissures typically do not have other complications aside from pain and bleeding.

2.
The only definitive solution for chronic anal fissures is surgery, and even after the procedure, proper care is necessary to prevent recurrence.

3.
These two medications have similar active ingredients, but suppositories can better contact the internal wounds of the anus.
If using a suppository is uncomfortable, it is acceptable to apply the ointment inside the anus; the therapeutic effect will be the same.

4.
Although the probability of developing colorectal cancer at the age of 21 is not zero, it is generally very low.
It is recommended to maintain a light diet and a good lifestyle.
Spicy, irritating, and greasy foods should be avoided, and increasing dietary fiber intake can be beneficial.
If symptoms persist without improvement, it is advisable to consult a physician for medication or to undergo a colonoscopy.

Reply Date: 2020/09/29

More Info

Managing chronic anal fissures can indeed be a challenging and distressing experience, especially when they are recurrent. Let's address your concerns one by one.

1. Recurrent Fissures and Long-term Consequences: Chronic anal fissures can be quite painful and may lead to a cycle of healing and re-injury, particularly if constipation persists. While occasional fissures may not lead to severe complications, repeated trauma can cause changes in the anal sphincter muscle, potentially leading to chronic pain or even anal sphincter dysfunction over time. This could result in issues such as incontinence or persistent pain. Therefore, it is essential to manage your bowel habits effectively to minimize the risk of recurrence.

2. Surgical vs. Conservative Management: It is common for younger patients to be advised against surgery unless absolutely necessary, as the risks may outweigh the benefits. Conservative management typically includes dietary modifications (increasing fiber intake), hydration, and the use of topical treatments such as nitroglycerin ointment or calcium channel blockers to promote healing and reduce sphincter pressure. If these measures fail and your quality of life is significantly affected, surgical options such as lateral internal sphincterotomy may be considered. This procedure can provide long-term relief by reducing the tension in the anal sphincter, allowing the fissure to heal.

3. Suppositories vs. Topical Creams: Anal suppositories and topical creams for hemorrhoids or fissures can have different effects. Suppositories may provide localized relief and help soften stool, but they can also cause discomfort if you have an existing fissure. Topical creams, on the other hand, can provide immediate relief from pain and inflammation. If you find suppositories uncomfortable, it may be worth discussing alternative treatments with your healthcare provider.

4. Colonoscopy Considerations: Your concern about undergoing a colonoscopy is valid, especially with a history of recurrent bleeding. While the preparation for a colonoscopy typically involves laxatives that can exacerbate fissures, it is crucial to weigh the risks and benefits. If you have persistent bleeding, it is advisable to consult with a gastroenterologist. They can provide guidance on how to prepare for the procedure while minimizing the risk of aggravating your fissures. It is generally recommended to have a colonoscopy if there are concerning symptoms, such as significant changes in bowel habits, unexplained weight loss, or persistent bleeding, regardless of fissure history.

In conclusion, managing chronic anal fissures involves a combination of dietary changes, topical treatments, and possibly surgical options if conservative measures fail. It is essential to maintain open communication with your healthcare providers about your symptoms and concerns. Regular follow-ups can help monitor your condition and adjust treatment as necessary. If you continue to experience significant anxiety or distress related to your fissures, consider discussing this with your doctor, as mental health support can also be beneficial in managing chronic conditions.

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