Anal Pain and Bleeding During Bowel Movements: When to Seek Medical Help

Pain at the anal opening and slight bleeding during bowel movements?

Good morning, Dr.
Chen.
Two weeks ago, I noticed bright red bleeding after a bowel movement, and my stool was hard and bulky at that time.
I have had similar experiences before and thought it was an anal fissure.
However, since then, every time I have a bowel movement, I experience sharp pain at the anal opening (with blood), which causes me to control the release of my stool by slowly relaxing and tightening my anus to prevent it from coming out too quickly.
As a result, I now feel a lot of pressure when using the restroom, and my stool has become thinner and segmented due to my fear of pain during bowel movements.
After researching online, I started changing my diet last week, drinking more water and eating more fruits and vegetables, and soaking my buttocks in warm water at night.
There has been some improvement, but I still feel a slight sharp pain at the anus during bowel movements (after one instance of diarrhea, there was no pain, but I felt a slight burning sensation as the stool passed the anal opening).
In the past, my anal fissure symptoms would typically resolve within a week, but this time it has been almost two weeks, and the sharp pain has only decreased, with no bleeding or just a little bit of bleeding.
Should I continue to monitor my condition, or should I seek medical attention directly?

Niming, 30~39 year old female. Ask Date: 2021/05/10

Dr. Chen Jiaming reply Surgery

The severity of anal fissures can vary with each occurrence.
If increasing water intake to soften stools does not lead to improvement, it is recommended to consult a colorectal surgeon for further evaluation.
In cases of recurrent fissures, surgical intervention (such as sphincterotomy to reduce anal sphincter pressure) may also be considered for treatment.

Reply Date: 2021/05/10

More Info

Experiencing anal pain and bleeding during bowel movements can be concerning, and it's important to understand when to seek medical help. Based on your description, it seems that you may be dealing with a condition known as anal fissure, which is a small tear in the lining of the anus. This condition often results in sharp pain during bowel movements and can lead to bleeding, especially if the stool is hard or difficult to pass.

Given that you have experienced fresh red blood during bowel movements and sharp pain, it is wise to take your symptoms seriously. The fact that you are modifying your diet to include more water, fruits, and vegetables is a positive step, as these changes can help soften your stool and make bowel movements less painful. Additionally, soaking in warm water can provide relief and promote healing.

However, since your symptoms have persisted for two weeks, and you are still experiencing pain and occasional bleeding, it may be time to consider seeking medical attention. Here are some reasons why you should see a healthcare provider:
1. Persistent Symptoms: If your symptoms do not improve significantly within a week or two, it is advisable to consult a doctor. Chronic fissures can develop if the initial tear does not heal properly, leading to ongoing pain and discomfort.

2. Increased Pain or Bleeding: If you notice an increase in pain or if the bleeding becomes more pronounced, it is essential to seek medical help. This could indicate a more serious issue, such as an infection or another underlying condition.

3. Difficulty with Bowel Movements: If you find yourself straining excessively or if your bowel movements become increasingly difficult, this can exacerbate the fissure and lead to further complications.

4. Signs of Infection: If you experience fever, chills, or any signs of infection (such as increased redness, swelling, or discharge), you should seek immediate medical attention.

5. Other Symptoms: If you notice any other concerning symptoms, such as changes in bowel habits, weight loss, or abdominal pain, these warrant a visit to a healthcare provider.

When you visit a doctor, they may perform a physical examination and possibly recommend treatments such as topical anesthetics, stool softeners, or other medications to promote healing and alleviate pain. In some cases, if conservative measures do not work, surgical options may be considered.

In summary, while dietary changes and home remedies can be effective for managing mild cases of anal fissures, your ongoing symptoms suggest that it may be time to seek medical advice. Early intervention can help prevent complications and promote healing, allowing you to return to normal bowel function without pain. Don't hesitate to reach out to a healthcare professional for a thorough evaluation and appropriate treatment.

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