Chronic Anal Fissures: Symptoms, Causes, and Complications

About anal fissures?

Hello Doctor, since I had hemorrhoid surgery at the end of February, I have been experiencing rectal bleeding during bowel movements starting a month later.
The doctors I consulted said it was just skin tears and fissures.
I inquired about the possibility of anal stenosis, but the doctor ruled that out.
I also had a colonoscopy, which showed no issues.
However, this symptom has persisted until now; sometimes it improves for four to five days and then recurs, while other times it occurs for several consecutive days.
The bowel movements are mostly painless, and I often notice blood when passing soft (but formed) stools.
The diameter of the stool is roughly the width of two fingers...
The blood is mostly seen on the toilet paper.
I am using suppositories daily, taking a bath once a night, and increasing my water, vegetable, and fruit intake, but my condition has not improved.
This situation makes me anxious every time I go to the bathroom, and I am worried about the possibility of developing a fistula...
I would like to ask the doctor if this ongoing issue could lead to any complications? Would this be considered chronic anal fissure? Thank you.

Niming, 30~39 year old female. Ask Date: 2021/12/17

Dr. Ke Fangxu reply Surgery

The typical symptoms of an anal fissure include pain during bowel movements accompanied by slight bleeding.
The common causes are often constipation or diarrhea.
If there is no pain, it is likely not an anal fissure and is unrelated to a fistula; it may be due to residual hemorrhoidal tissue bleeding.
If the amount of bleeding is minimal, there are usually no significant complications.

Reply Date: 2021/12/17

More Info

Chronic anal fissures are a common condition that can arise after surgical procedures such as hemorrhoidectomy, as you have experienced. Understanding the symptoms, causes, and potential complications of chronic anal fissures is crucial for effective management and prevention of further issues.

Symptoms
Chronic anal fissures typically present with:
- Bleeding: This is often seen on toilet paper after a bowel movement, as you described. The blood is usually bright red, indicating fresh blood from the anal area.

- Pain: While you mentioned that you do not experience pain during bowel movements, many individuals with fissures report significant pain, especially during and after defecation. However, chronic fissures can sometimes be less painful than acute ones.

- Itching or irritation: The area around the fissure may become irritated, leading to discomfort.

- Fissure appearance: Chronic fissures may have a characteristic appearance, often described as a tear or crack in the anal mucosa, and may have raised edges.

Causes
Chronic anal fissures can develop due to:
- Trauma: This can occur from passing hard stools, which may be exacerbated by constipation or straining during bowel movements.

- Surgical procedures: As in your case, surgery for hemorrhoids can lead to changes in the anal canal that may predispose individuals to fissures.

- Chronic diarrhea: Frequent loose stools can also irritate the anal area.

- Underlying conditions: Conditions such as inflammatory bowel disease (IBD) or infections can contribute to fissure formation.

Complications
If left untreated, chronic anal fissures can lead to several complications:
- Fistula formation: In some cases, chronic fissures can develop into anal fistulas, which are abnormal connections between the anal canal and the skin.

- Chronic pain: Persistent fissures can lead to ongoing discomfort and anxiety about bowel movements.

- Infection: The fissure can become infected, leading to further complications and the need for more intensive treatment.

- Anal stenosis: Although your doctor indicated that you do not have anal stenosis, chronic fissures can sometimes lead to narrowing of the anal canal, which can complicate bowel movements.

Management and Treatment
Given your ongoing symptoms and the lack of improvement despite conservative measures, it may be beneficial to consider the following:
- Topical treatments: Medications such as nitroglycerin ointment or calcium channel blockers can help relax the anal sphincter and promote healing.

- Botulinum toxin injections: This can be considered for chronic fissures that do not respond to topical treatments, as it can help reduce sphincter spasm.

- Surgical options: If conservative measures fail, surgical options such as lateral internal sphincterotomy may be indicated to relieve tension and promote healing.

Recommendations
- Dietary modifications: Continue to focus on a high-fiber diet and adequate hydration to ensure soft stools, which can help reduce trauma during bowel movements.

- Regular follow-up: It’s essential to maintain regular follow-ups with your healthcare provider to monitor the condition and adjust treatment as necessary.

- Avoiding straining: Try to avoid straining during bowel movements, as this can exacerbate fissures.

In conclusion, while your symptoms may suggest chronic anal fissures, it is essential to work closely with your healthcare provider to explore all potential treatment options and monitor for any complications. If you have concerns about the risk of developing a fistula or other complications, do not hesitate to discuss these with your doctor, as they can provide tailored advice and management strategies based on your specific situation.

Similar Q&A

Chronic Anal Fissures: Impact on Bowel Health and Healing

1. Based on your description, it sounds like you may be experiencing chronic anal fissures. Chronic anal fissures are defined as fissures that persist for more than eight weeks and can cause recurring pain and discomfort. 2. If the fissures have not healed over time, they can le...

Dr. Zhang Shuhao reply Surgery
Acute anal fissures typically heal within about a week if the wound is allowed to rest properly. However, if the affected area is repeatedly injured and symptoms persist for more than six weeks, it is classified as a chronic anal fissure. This may be due to tight anal sphincter m...

Understanding Chronic Anal Fissures: Healing Time and Pain Management

I have had an anal fissure for 8 months. How much longer will it take to heal? My symptoms include pain but no bleeding. I have been worried about this every day. Thank you, doctor.

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. The fundamental treatment is to improve bowel habits, along with warm sitz baths. Over-the-counter hemorrhoid suppositor...

Chronic Anal Fissures: Risks of Untreated Conditions and Alternatives

If chronic anal fissures are left untreated, they can lead to several complications. Although you may only experience mild pain during bowel movements and it doesn't significantly affect your daily life, the fissure can become more severe over time. This may result in increa...

Dr. Wang Qichao reply Surgery
Hello: Chronic anal fissures typically present with a triad of symptoms, which includes (1) ulceration, (2) anal tags, and (3) anal papillae. The chances of healing are usually low, and surgical intervention is often required. It is recommended that you first visit a colorectal s...

Understanding Chronic Anal Fissures: Symptoms, Causes, and Complications

Hello, doctor. Since I had hemorrhoid surgery at the end of February, I have been experiencing rectal bleeding during bowel movements starting a month after the surgery. The doctors I consulted said it was just skin tears and fissures. I inquired about the possibility of anal ste...

Dr. Ke Fangxu reply Surgery
The typical symptoms of an anal fissure include pain during bowel movements accompanied by slight bleeding. The common causes are constipation or diarrhea. If there is no pain, it is likely not an anal fissure and is unrelated to a fistula; it may be due to residual hemorrhoidal ...