Anal Fissures: When to Seek Medical Attention

Anal fissure issues?

Hello doctor, I usually have smooth bowel movements, but today it was a bit difficult, and after straining a little, I felt a sharp pain in my anus.
I gently spread the area and took a photo with my phone, discovering several areas of broken skin on both sides.
I found several articles online stating that anal fissures typically occur at the anterior and posterior ends, and if they are on the sides, it is something to be cautious about.
Additionally, I had an anal abscess last year.
I would like to ask the doctor if this situation requires a hospital examination.

Mr. Huang, 20~29 year old female. Ask Date: 2021/07/12

Dr. Ke Fangxu reply Surgery

Not every case of anal skin breakdown indicates an anal fissure.
It is important to check both sides for any other lesions.
If there are no palpable masses or signs of redness, swelling, or pain, you can continue to observe the condition.
Otherwise, it is advisable to consult a physician to avoid delaying diagnosis and treatment.

Reply Date: 2021/07/12

More Info

Anal fissures are small tears in the lining of the anus, often resulting from passing hard stools or straining during bowel movements. They can cause significant discomfort, including sharp pain during and after bowel movements, and may also lead to bleeding. Your description of experiencing pain after a particularly difficult bowel movement, along with the discovery of skin breaks on either side of the anus, raises some important considerations.

Given your history of an anal abscess, it is prudent to be cautious. While many anal fissures occur at the posterior or anterior midline, lateral fissures can sometimes indicate other underlying issues, such as inflammatory conditions or even infections. Since you have previously experienced an anal abscess, which is an infection that can lead to further complications if not properly addressed, it is advisable to seek medical attention.

Here are some key points to consider regarding when to seek medical attention for anal fissures:
1. Severity of Pain: If the pain is severe and persistent, or if it worsens over time, it is essential to consult a healthcare provider. Anal fissures can be quite painful, but if the pain is debilitating, it may indicate a more serious condition.

2. Bleeding: While some bleeding can occur with anal fissures, if you notice significant or persistent bleeding, it is crucial to seek medical evaluation. This is especially important if the bleeding is bright red and occurs with every bowel movement.

3. Signs of Infection: If you experience symptoms such as fever, increased swelling, or discharge from the anal area, these may indicate an infection that requires prompt medical attention.

4. History of Abscess: Given your previous experience with an anal abscess, it is wise to be vigilant. An abscess can recur or lead to complications, so any new symptoms should be evaluated by a healthcare professional.

5. Duration of Symptoms: If your symptoms persist for more than a few days without improvement, it is advisable to seek medical advice. Chronic fissures may require different management strategies, including topical treatments or even surgical intervention.

6. Impact on Daily Life: If the pain or discomfort is affecting your daily activities or quality of life, it is a good reason to consult a physician.

In your case, I recommend scheduling an appointment with a healthcare provider, preferably a gastroenterologist or a colorectal surgeon, who can perform a thorough examination. They may conduct a physical examination and possibly recommend additional tests to rule out any underlying conditions. Treatment options may include dietary changes to soften stools, topical anesthetics, or medications to promote healing.

In conclusion, while many anal fissures can heal with conservative management, your history and current symptoms warrant a medical evaluation to ensure that there are no complications or underlying issues that need to be addressed. Don't hesitate to seek help; early intervention can lead to better outcomes and relief from discomfort.

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