Hemorrhoids and Anal Fissures: A Teen's Guide to Relief

Hemorrhoids and anal fissures?

Dear Dr.
Lin Ming-Hui,
I am currently a senior high school student with a normal routine and diet, and I also exercise regularly.
However, I have had a bad habit of constipation since childhood, having a bowel movement approximately every three days.
My stools are hard, and sometimes they are so hard that I experience bleeding.
I recently visited a doctor, and there were no abnormalities found.
Since entering my senior year, I have been encouraging myself to have a bowel movement every morning and to drink more water, which has gradually improved the bleeding situation.
However, if I suddenly drink too little water or eat too few fruits and vegetables, my stools may become hard again the next day.
Additionally, when having a bowel movement, I experience a sharp, knife-like pain on the right side of my anus, which can range from mild discomfort that goes away after the bowel movement to severe pain that lasts for a day.

Sometimes, in addition to the pain, I notice blood.
The stool itself is brown or yellow, and the blood appears bright red on the stool, not mixed in, but rather as small streaks of fresh blood on top of the stool.
The amount of blood is very minimal, and there is no blood in the toilet bowl or on the toilet paper when wiping.
The frequency of bleeding is low, but it has been occurring for several years, always when my stools are too hard.
There are also times when I experience significant anal pain without any bleeding.
Could this be a sign of anal fissure? I have read online that anal fissures usually result in dripping blood after a bowel movement, and there is blood in the toilet, but my situation does not seem that severe.
I would like to ask if my symptoms could indicate something else, or if it is a mild or chronic anal fissure.
What can I do to improve this condition?
Additionally, after each bowel movement, I always feel a sensation of something foreign on the left side of my anus, which does not reach the level of needing to have a bowel movement, but it feels like there is something there.
It is not painful.
Could this be internal hemorrhoids? Is there a way to resolve this? Also, does elevating my legs or standing on my toes help promote blood circulation in that area?
Thank you for your guidance.

(P.S.
I do not experience abdominal pain, and my stools are not consistently thin or mucus-like.)

Vicky, 10~19 year old female. Ask Date: 2021/04/05

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, if you are drinking too little water and consuming insufficient fruits and vegetables, you may experience a stinging sensation during bowel movements, and sometimes there may be blood in your stool, which could indicate anal fissures.
It is recommended to pay attention to your hydration and fiber intake to maintain regular bowel movements.
If symptoms persist, it is advisable to follow up with a colorectal specialist to rule out any other issues.
The sensation of a foreign body on the left side of the anus, as described, could be hemorrhoids.
It is recommended to keep your bowel movements regular and avoid prolonged sitting or standing.
Moderate exercise, such as elevating your legs or doing calf raises, can also be beneficial.
If symptoms continue, please consult a colorectal specialist for further evaluation.
Wishing you peace and health! Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Department of Gastroenterology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2021/04/05

More Info

Hello! Thank you for reaching out with your concerns about hemorrhoids and anal fissures. It's great to hear that you've been proactive about your health, especially with your dietary habits and hydration. Let's break down your symptoms and discuss potential causes and remedies.

From what you’ve described, it sounds like you may be experiencing symptoms consistent with both anal fissures and possibly hemorrhoids. Anal fissures are small tears in the lining of the anus, often caused by passing hard stools. The fact that you experience sharp pain during bowel movements, especially when your stools are hard, suggests that this could be a contributing factor. The presence of bright red blood on the surface of your stool, rather than mixed in with it, is also a common sign of an anal fissure.
On the other hand, hemorrhoids are swollen veins in the lower rectum and anus, which can also cause pain, discomfort, and bleeding. The sensation of having something in your rectum after a bowel movement could indicate internal hemorrhoids, especially if you feel pressure or discomfort in that area.
Here are some recommendations to help alleviate your symptoms and improve your bowel health:
1. Increase Fiber Intake: Aim to consume a high-fiber diet, including fruits, vegetables, whole grains, and legumes. Fiber helps to soften stools and makes them easier to pass, reducing the risk of fissures and hemorrhoids.

2. Stay Hydrated: Drinking plenty of water is crucial. Aim for at least 8 glasses a day. Proper hydration helps keep your stools soft.

3. Regular Bowel Habits: Try to establish a regular schedule for bowel movements. This can help train your body and reduce the likelihood of constipation. If you feel the urge to go, don’t delay.

4. Avoid Straining: When you do have a bowel movement, try not to strain. If you find that you are having difficulty, consider using a stool softener or a fiber supplement after discussing it with a healthcare provider.

5. Warm Baths: Taking warm baths can help soothe the area and relieve discomfort. This can be particularly helpful after bowel movements.

6. Over-the-Counter Treatments: There are topical treatments available that can help relieve pain and inflammation associated with hemorrhoids and fissures. Look for creams that contain hydrocortisone or witch hazel.

7. Exercise: Regular physical activity can help stimulate bowel function and reduce constipation. Aim for at least 30 minutes of moderate exercise most days of the week.

8. Consult a Healthcare Provider: Since you’ve been experiencing these symptoms for several years, it would be wise to consult with a healthcare provider for a thorough examination. They can confirm whether you have anal fissures, hemorrhoids, or another condition, and provide tailored treatment options.

Regarding your question about elevating your legs, this can indeed help with circulation, especially if you are sitting for long periods. However, it’s essential to maintain a comfortable position while using the restroom to avoid straining.

In summary, your symptoms could be indicative of anal fissures and possibly hemorrhoids, both of which can be managed with lifestyle changes and proper care. If your symptoms persist or worsen, please seek medical advice to rule out any other underlying conditions. Remember, taking care of your digestive health is crucial, and being proactive is the best approach. Thank you for your question, and I hope this information helps you find relief!

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