Anal Fissures: Causes, Symptoms, and Management

Questions about anal fissures?

Three years ago, I had an anal fissure caused by diarrhea.
I went to a teaching hospital for a rectal examination, and the doctor immediately noted that there was a large tear.
It took about two weeks for it to heal on its own.
Since then, I have experienced recurrences when I have hard stools or diarrhea (usually triggered by drinking milk), but there hasn't been any bleeding the next day.
A year ago, after a minor surgery and taking antibiotics, I started experiencing irritable bowel syndrome along with bloating.
The doctor suggested I take probiotics last week, and I bought Wakamoto, which improved my condition, but I still have constipation and a feeling of fullness in my abdomen.
This morning, I drank a flavored milk and had a sudden urge to have a bowel movement, feeling like I had diarrhea.
I expelled a lot of stool, which was of normal shape, about the usual amount I would pass in four days, along with a lot of gas.
However, when I wiped with toilet paper, there was quite a bit of bright red blood, which was only on the tip of the stool, not throughout.
Now I feel slight pain in the anal area, but the discomfort in my abdomen has completely disappeared.
I would like to ask the doctor if this could be related to the anal fissure.
Could having a large and urgent bowel movement cause this? My weight has not changed.

Niming, 30~39 year old female. Ask Date: 2020/11/30

Dr. Ke Fangxu reply Surgery

The typical symptoms of anal fissures include pain during bowel movements accompanied by slight bleeding.
The common causes are often constipation or diarrhea, which can lead to large or excessive stools.
The fundamental treatment is to improve bowel habits, along with warm sitz baths.
Warm sitz baths can help relieve 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: 2020/11/30

More Info

Anal fissures are small tears in the lining of the anus, often caused by trauma during bowel movements, particularly when passing hard or large stools. They can also occur due to chronic diarrhea, which seems to be a factor in your case. Given your history of anal fissures and the symptoms you are currently experiencing, it is indeed possible that you are dealing with a recurrence of an anal fissure.

Causes of Anal Fissures
1. Trauma: The most common cause is trauma to the anal canal, which can occur from passing hard stools or during episodes of diarrhea.

2. Chronic Diarrhea: As you mentioned, drinking milk can lead to diarrhea for you, which may contribute to the development of fissures.

3. Constipation: Straining during bowel movements can also lead to fissures.

4. Inflammatory Conditions: Conditions like Crohn's disease or ulcerative colitis can lead to fissures.

5. Infections: Certain infections can cause inflammation and lead to fissures.

Symptoms
- Pain: Sharp pain during and after bowel movements is a hallmark symptom.

- Bleeding: Bright red blood on the toilet paper or in the stool can occur, as you described.

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

- Spasms: Some individuals experience anal sphincter spasms, which can exacerbate pain.

Management and Treatment
1. Dietary Modifications: Increasing fiber intake can help soften stools and reduce straining. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying hydrated is also crucial.

2. Stool Softeners: Over-the-counter stool softeners can help ease bowel movements.

3. Topical Treatments: Applying topical anesthetics or nitroglycerin ointment can help relieve pain and promote healing.

4. Warm Sitz Baths: Soaking in warm water can help relax the anal sphincter and promote healing.

5. Probiotics: As you mentioned, probiotics like Wakamoto can help improve gut health and may alleviate some gastrointestinal symptoms, including constipation and bloating.

6. Avoiding Irritants: If you suspect that dairy products are causing diarrhea, consider reducing or eliminating them from your diet.

When to Seek Medical Attention
If you continue to experience bleeding, severe pain, or if the fissure does not heal with conservative measures, it is essential to consult a healthcare provider. They may recommend further evaluation, such as a colonoscopy, to rule out other underlying conditions. In some cases, surgical intervention may be necessary for chronic fissures that do not respond to conservative treatment.

Conclusion
Based on your symptoms and history, it is plausible that you are experiencing another anal fissure, especially after episodes of diarrhea. It is essential to manage your bowel habits and dietary intake to prevent further irritation. If symptoms persist or worsen, please seek medical advice for a thorough evaluation and tailored treatment plan. Remember, maintaining a healthy gut and avoiding straining during bowel movements are key to preventing future occurrences.

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