Managing Chronic Anal Fissures: Symptoms, Treatments, and Recovery

Chronic anal fissure

Hello Doctor: I have a chronic anal fissure issue that had previously healed, but a few days ago it reopened due to constipation.
Sometimes it bleeds, and I've been experiencing significant pain after using the restroom.
I feel a friction sensation at the site of the injury when sitting or standing, which often takes several hours to alleviate.
Additionally, I have a sentinel pile that has suddenly swollen in the past few days.
I would like to ask you: 1.
Is the sudden swelling of the sentinel pile related to the recurrence of the anal fissure? Is there a possibility that it will decrease in size afterward, or are there any solutions to address this? 2.
I still have some ointment left from my previous treatment, and I plan to use it for relief.
I have also been doing warm sitz baths.
How long might it take to heal? Do I need to see a doctor? 3.
Can the pain from the anal fissure cause discomfort when standing or sitting, or could it be due to other reasons?

Jun, 20~29 year old female. Ask Date: 2020/10/06

Dr. Ke Fangxu reply Surgery

1.
Yes, it can shrink afterwards but will not completely disappear.
The only way for sentinel polyps to disappear is through surgical removal.

2.
If the pain and bleeding are only mild, you can initially apply medication and take warm sitz baths.
If there is no improvement after a week, it is best to consult a physician for evaluation.

3.
Yes, exertion can cause pain as well; any contraction of the anal sphincter can lead to discomfort.

Reply Date: 2020/10/06

More Info

Managing chronic anal fissures can be quite challenging, especially when they are exacerbated by conditions like constipation. Your symptoms, including pain during bowel movements, bleeding, and discomfort while sitting or standing, are common in individuals suffering from anal fissures and associated conditions like sentinel piles (or sentinel hemorrhoids). Let's address your questions one by one.

1. Sentinel Hemorrhoid Swelling: The sudden enlargement of your sentinel hemorrhoid is likely related to the recurrence of your anal fissure. When a fissure occurs, it can lead to increased pressure and irritation in the anal area, which may cause the sentinel hemorrhoid to swell. This is a common response as the body attempts to protect the area from further injury. In many cases, the swelling can subside once the fissure heals, but it may take time. To help reduce the swelling, maintaining a high-fiber diet, staying hydrated, and using stool softeners can be beneficial. If the swelling persists or worsens, it may be worth consulting a healthcare professional for further evaluation.

2. Topical Treatments and Recovery Time: Continuing to use your prescribed topical ointment is a good idea, as it can help soothe the area and promote healing. Warm sitz baths are also effective in providing relief and promoting blood flow to the area, which can aid in healing. The recovery time for anal fissures can vary widely depending on the severity of the fissure and your overall health. Generally, with appropriate care, many fissures can heal within a few weeks. However, if you notice that your symptoms are not improving after a week or two of treatment, or if they worsen, it would be prudent to see a doctor. They may recommend additional treatments, such as topical nitroglycerin or calcium channel blockers, which can help relax the anal sphincter and promote healing.

3. Pain While Sitting or Standing: The pain you experience while sitting or standing is likely due to the fissure itself. The anal area is sensitive, and any pressure or friction can exacerbate the pain. Additionally, if the sentinel hemorrhoid is inflamed, it can contribute to discomfort in these positions. It’s essential to avoid straining during bowel movements, as this can worsen the fissure. Using a cushion while sitting can help alleviate some pressure and discomfort.

In summary, managing chronic anal fissures involves a combination of dietary changes, topical treatments, and possibly medical intervention if symptoms persist. It’s crucial to listen to your body and seek medical advice if your condition does not improve or if you experience significant changes in your symptoms. Remember, maintaining a healthy bowel regimen is key to preventing future occurrences of fissures. If you have any further concerns or questions, don’t hesitate to reach out to your healthcare provider for personalized advice and treatment options.

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