Anal Fissures: Causes, Symptoms, and Treatment Options

Anal fissure issues?

Hello Doctor, I have a few questions to ask you: I have been experiencing anal fissures for about a month now.
At first, during bowel movements, the initial part of the stool was hard and required some effort to pass.
The front part resembled small, dark, pellet-like stools, while the latter part was soft.
When the stool passed, I felt a tearing sensation at the anus, and there was a bit of fresh blood on the toilet paper.
I didn't think much of it at the time, but during another bowel movement, I again had the same hard, pellet-like stool at the front and soft stool at the back.
After I finished, I saw that the entire toilet was covered in blood, including the toilet paper, which alarmed me, so I rushed to see a doctor.
After an examination, the doctor diagnosed me with an anal fissure and prescribed a stool softener and ointment.
After using the medication, everything returned to normal, and my bowel movements became softer.
Once my stool softened, I experienced no pain or bleeding during bowel movements.
I then stopped the medication, but about two weeks later, the same issues returned.
The stool was again hard at the front, resembling pellet-like stools, and required effort to pass, while the back was soft and yellowish.
The pain was only felt at the moment the stool was about to come out, with a tearing sensation at the anus, and there was blood on the toilet paper again.
After bowel movements, I generally did not have much pain, just a slight tearing sensation around the anus that lasted for about an hour.
This situation has persisted for nearly a month.
While on medication, I had no pain or bleeding, but once I stopped, the hard stool returned within a few days.
I feel like I am repeatedly injuring the same area, preventing it from healing, and there is considerable bleeding.
As long as I am not on medication, this cycle continues, which is very distressing for me.
I have previously undergone a colonoscopy, and the doctor confirmed it was just a simple anal fissure with no other issues.
Therefore, I would like to ask you, Doctor, what is my problem? 1.
If constipation is causing the front part of the stool to be too hard, how can I improve this? Am I solely reliant on stool softeners? 2.
Or is there another underlying issue with my condition?

Niming, 20~29 year old female. Ask Date: 2022/03/07

Dr. Ke Fangxu reply Surgery

1.
If you want to avoid relying on stool softeners, it's important to increase your intake of dietary fiber and fluids.
2.
The typical symptoms of anal fissure include pain during bowel movements accompanied by slight bleeding.
The pain can persist for several days, sometimes exceeding a week.
The common causes are often constipation or diarrhea.
The fundamental treatment involves addressing the bowel movement issues, along with warm sitz baths.
Warm sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
You can also purchase over-the-counter hemorrhoid suppositories for use.
If symptoms persist without improvement, it is advisable to consult a physician for further evaluation.

Reply Date: 2022/03/07

More Info

Anal fissures are small tears in the lining of the anus, often caused by passing hard or large stools. They can lead to significant discomfort, pain, and bleeding during bowel movements, as you've described. Your experience of having hard, pellet-like stools followed by softer stools indicates that you may be dealing with constipation, which is a common cause of anal fissures.

Causes of Anal Fissures
1. Constipation: Hard stools can stretch the anal canal and cause tearing.

2. Diarrhea: Frequent loose stools can also irritate the anal area.

3. Childbirth: Women may experience fissures during or after childbirth.

4. Anal Intercourse: This can lead to trauma in the anal region.

5. Underlying Conditions: Conditions like Crohn's disease or anal cancer can also contribute to fissure development.

Symptoms
- Pain during bowel movements: This is often described as a sharp, tearing sensation.

- Bleeding: Bright red blood on toilet paper or in the toilet bowl after a bowel movement.

- Itching or irritation: This can occur around the anal area.

- Spasms: Some individuals may experience muscle spasms in the anal sphincter.

Treatment Options
1. Dietary Changes: Increasing fiber intake can help soften stools. Foods high in fiber include fruits, vegetables, whole grains, and legumes. Aim for at least 25-30 grams of fiber per day.

2. Hydration: Drinking plenty of water can help prevent constipation.

3. Stool Softeners: Over-the-counter stool softeners can be beneficial, especially if dietary changes alone are not enough.

4. Laxatives: If necessary, mild laxatives can be used, but they should not be relied upon long-term.

5. Topical Treatments: Creams or ointments containing hydrocortisone or nitroglycerin can help reduce pain and promote healing.

6. Warm Sitz Baths: Soaking the anal area in warm water can relieve pain and promote blood flow to the area, aiding healing.

7. Avoid Straining: When using the bathroom, try not to strain or sit for prolonged periods.

When to Seek Further Help
If your symptoms persist despite these measures, or if you experience severe pain, significant bleeding, or signs of infection (such as fever or pus), it is essential to consult a healthcare provider. They may recommend further evaluation, such as an anoscopy, to rule out other conditions.

Conclusion
Your situation appears to be a classic case of an anal fissure exacerbated by constipation. While stool softeners and dietary changes are effective, it is crucial to maintain these changes consistently to prevent the recurrence of hard stools. If you find that your symptoms continue to return after stopping medication, it may be beneficial to discuss a long-term management plan with your healthcare provider. This could include ongoing dietary adjustments, regular use of stool softeners, or even referral to a gastroenterologist for further evaluation. Remember, healing takes time, and maintaining a healthy bowel routine is key to preventing future issues.

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