Anal Fissures: Causes, Treatments, and Relief Options

Anal fissures and anal problems?

Hello, Doctor.
I have been experiencing anal fissures since last year.
I visited a doctor and received medication (at Mackay Memorial Hospital).
It improved somewhat, but I have been having recurrent episodes.
Later, I took Laxative, which helped.
However, during the Lunar New Year, due to work commitments, I didn't have time to take my medication, resulting in hard stools (which caused pain all day).
Every time I use the restroom, it is very painful.
Last month, I experienced intense itching in my anus at night, which kept me awake, so I went to see a doctor (at a small clinic).
The doctor prescribed painkillers and ointment, which helped.
After showering, I immediately apply the medication and use a hairdryer to dry the area.
However, after nearly two months of taking Laxative, I still experience significant pain during bowel movements, and afterward, my anus itches.
Sometimes, the itching is quite severe.
May I ask, Doctor, when I went to Mackay, they inserted their fingers into my anus, which was very uncomfortable.
Is it possible to examine without inserting fingers, just by visual inspection? Thank you.

Mr. Pi, 20~29 year old female. Ask Date: 2022/03/05

Dr. Zhang Shuhao reply Surgery

Anal fissures are primarily caused by tight anal muscles combined with straining during bowel movements.
Laxatives can help supplement dietary fiber, but it is essential to drink plenty of water to avoid adverse effects.
It is recommended to consume more fruits and vegetables to prevent constipation, and to take warm sitz baths two to three times a day, gently patting dry before applying ointment, without the need for a hairdryer.
Acute anal fissures typically heal within about a week if the area is not subjected to further strain.
However, if they recur frequently, they may progress to chronic anal fissures or even ulcers, at which point surgical intervention may be necessary to remove the ulcer and relax the sphincter muscle.
A digital rectal examination in an outpatient setting is the most accurate way to assess the condition, and if there is significant discomfort, it is important to check for issues such as anal stenosis or excessive tightness of the sphincter muscle.

Reply Date: 2022/03/05

More Info

Anal fissures are small tears in the lining of the anus, often resulting in pain, bleeding, and discomfort during bowel movements. Understanding the causes, treatments, and relief options for anal fissures is crucial for managing this condition effectively.

Causes of Anal Fissures
1. Hard Stools: One of the most common causes of anal fissures is passing hard or large stools. This can occur due to constipation, which is often exacerbated by a low-fiber diet or inadequate fluid intake.

2. Straining: Excessive straining during bowel movements can lead to tears in the anal lining. This is often associated with constipation but can also occur in individuals with diarrhea.

3. Childbirth: Women may experience anal fissures during childbirth due to the pressure and trauma to the anal area.

4. Inflammatory Conditions: Conditions such as Crohn's disease or ulcerative colitis can lead to chronic inflammation in the gastrointestinal tract, increasing the risk of fissures.

5. Anal Intercourse: Engaging in anal intercourse without adequate lubrication can also cause fissures.

Treatments for Anal Fissures
1. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining. Drinking plenty of water is also essential.

2. Topical Treatments: Over-the-counter creams and ointments, such as hydrocortisone or nitroglycerin ointment, can help relieve pain and promote healing. Your doctor may also prescribe stronger medications if necessary.

3. Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the anal area and promote healing.

4. Medications: Laxatives or stool softeners can help prevent constipation and make bowel movements easier.

5. Botulinum Toxin Injections: In some cases, injecting botulinum toxin into the anal sphincter can help relax the muscle and promote healing.

6. Surgery: If conservative treatments fail, surgical options such as lateral internal sphincterotomy may be considered. This procedure involves cutting a small portion of the anal sphincter muscle to relieve tension and promote healing.

Relief Options
1. Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain associated with anal fissures.

2. Hygiene Practices: Keeping the anal area clean and dry is essential. After bowel movements, gently clean the area with water and avoid using harsh soaps or wipes that can irritate the skin.

3. Avoiding Irritants: Avoiding scented toilet paper, soaps, and other irritants can help reduce discomfort.

Concerns About Examination
Regarding your concern about the discomfort associated with digital examinations, it is understandable that this can be uncomfortable. While a digital examination can provide valuable information about the condition of the anal canal, it is not always necessary. Many healthcare providers can assess the area visually, especially if the fissure is external or if there are visible signs of irritation or inflammation. You can discuss your preferences with your doctor and inquire about alternative examination methods.

Conclusion
Anal fissures can be a painful and frustrating condition, but with appropriate management, most individuals can find relief. It is essential to maintain a high-fiber diet, stay hydrated, and follow your doctor's recommendations for treatment. If symptoms persist or worsen, further evaluation and treatment options may be necessary. Always communicate openly with your healthcare provider about your symptoms and any concerns you may have regarding examinations or treatments.

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