Anal Fissures: Symptoms and Treatment Options

Anal fissure for one month?

In October, after experiencing hard stools, I developed an anal fissure.
Initially, it wasn't too bad, but later on, my bowel movements resembled goat droppings.
When wiping with toilet paper, there would be blood, and sometimes blood would drip during bowel movements.
This has continued until today, and I have recently experienced vague pain.
While showering, I noticed a hard lump near the anus, which is painful when pressure is applied.
What could these symptoms indicate?

Mr. Li, 10~19 year old female. Ask Date: 2020/11/01

Dr. Hong Yuanbin reply Internal Medicine

Based on your description, the most likely conditions are hemorrhoids or a benign cyst.
It is recommended to increase your intake of vegetables and exercise more to help soften your stools.
If the symptoms persist or worsen, you should consider seeing a general surgeon or a colorectal surgeon.
Thank you for your inquiry.

Reply Date: 2020/11/01

More Info

Anal fissures are small tears in the lining of the anus, often caused by passing hard or large stools. They can lead to significant discomfort and may be accompanied by bleeding, especially during bowel movements. Based on your description, it seems that you are experiencing classic symptoms of an anal fissure, including:
1. Pain during bowel movements: This is often sharp and can be severe, especially if the stool is hard or large.

2. Bleeding: The presence of blood on the toilet paper or in the toilet bowl after a bowel movement is a common sign of an anal fissure.

3. Hard lump: The hard lump you mentioned could be a sentinel pile, which is a small skin tag that can develop as a result of the fissure. It is not uncommon for fissures to lead to the formation of these tags.

Treatment Options
The treatment for anal fissures typically focuses on relieving pain, promoting healing, and preventing constipation. Here are some common approaches:
1. Dietary Changes: Increasing your fiber intake can help soften your stools, making them easier to pass. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Additionally, staying well-hydrated by drinking plenty of water can also help.

2. Stool Softeners: Over-the-counter stool softeners can be beneficial in preventing hard stools. Products like docusate sodium (Colace) can help make bowel movements less painful.

3. Topical Treatments: Applying topical anesthetics (like lidocaine) can help relieve pain during bowel movements. Additionally, topical nitroglycerin or calcium channel blockers (like nifedipine) can help relax the anal sphincter and promote healing.

4. Warm Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the area and promote healing.

5. Avoid Straining: It’s essential to avoid straining during bowel movements, as this can exacerbate the fissure. If you feel the urge to go, try not to delay it.

6. Medical Intervention: If conservative treatments do not provide relief, a healthcare provider may recommend further interventions. This could include botulinum toxin injections to relax the anal sphincter or, in more severe cases, surgical options to repair the fissure.

When to Seek Medical Attention
Given that you have been experiencing these symptoms for some time, it is advisable to consult a healthcare professional. They can perform a physical examination to confirm the diagnosis and rule out other potential issues, such as hemorrhoids or other anal conditions. If you notice any signs of infection (such as increased redness, swelling, or discharge), or if the pain becomes unbearable, seek medical attention promptly.

Conclusion
Anal fissures can be quite painful and distressing, but with appropriate treatment, most cases heal effectively. It’s crucial to address the underlying causes, such as hard stools, to prevent recurrence. If you have not already done so, please consider scheduling an appointment with a healthcare provider to discuss your symptoms and explore treatment options tailored to your needs.

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