Anal Fissures: Symptoms, Prevention, and Treatment Options

Is it a symptom of anal fissure? How can it be prevented?

Hello, I have an adequate water intake in my daily life, and my bowel movements are smooth with no hard stools.
However, I notice a very small amount of blood (less than a normal drop) almost every time I wipe after a bowel movement.
Upon observation, I found that there may be more than one wound, and they are mostly located closer to the perineum rather than near the anus.
I do not experience pain regularly, only when wiping or when water touches the area during bathing.
Could these symptoms indicate anal fissures? What treatment or prevention methods would you recommend? Thank you for your time!

KB, 20~29 year old female. Ask Date: 2022/04/27

Dr. Chen Ronghong reply Surgery

Hello KB, given your age, the presence of blood in your stool is more likely related to anal fissures or hemorrhoids.
You mentioned that there is usually no pain, and bleeding and pain only occur after wiping post-defecation, which strongly suggests the possibility of an anal fissure.
I recommend increasing your fluid and fiber intake in your diet, and when you feel the urge to have a bowel movement, go to the bathroom immediately to avoid holding it in, as this can lead to harder stools due to moisture absorption.
During bowel movements, consider using water to rinse or wet wipes.
You can also prepare a basin for warm sitz baths for about ten minutes, or rinse the anal area with warm water while showering.
If you try these methods and your symptoms do not improve, I suggest seeking medical evaluation to determine if you need a stool softener or topical ointment.

Reply Date: 2022/04/27

More Info

Anal fissures are small tears in the lining of the anus, which can cause discomfort and bleeding during bowel movements. Your description of experiencing slight bleeding after bowel movements, particularly when wiping, along with pain during wiping or bathing, suggests that you may indeed be dealing with anal fissures.

Symptoms of Anal Fissures
The primary symptoms of anal fissures include:
1. Pain: This is often sharp and can occur during or after bowel movements. In your case, you mentioned that you only feel pain when wiping or when water touches the area, which is consistent with fissures.

2. Bleeding: The blood you observe is typically bright red and may appear on toilet paper or in the toilet bowl. The fact that you see only a small amount of blood is common with fissures.

3. Itching or Irritation: Some individuals may experience itching around the anal area.

4. Visible Tear: In some cases, a fissure may be visible as a small tear or cut in the skin.

Causes
Anal fissures can occur due to various reasons, including:
- Straining during bowel movements: Even if your stools are soft, any straining can lead to fissures.

- Chronic diarrhea or constipation: Frequent bowel movements or hard stools can contribute to the development of fissures.

- Childbirth: Women may experience fissures after giving birth.

- Anal intercourse: This can also lead to fissures due to trauma to the anal area.

Prevention
To prevent anal fissures, consider the following strategies:
1. Maintain Soft Stools: Ensure your diet is high in fiber (fruits, vegetables, whole grains) and drink plenty of water to keep your stools soft.

2. Avoid Straining: When you feel the urge to have a bowel movement, try to go as soon as possible without straining.

3. Practice Good Hygiene: After bowel movements, gently clean the area with water and avoid harsh soaps. Pat the area dry instead of wiping vigorously.

4. Use Moist Wipes: Consider using moist wipes instead of toilet paper to reduce irritation.

5. Warm Baths: Taking warm baths can help soothe the area and promote healing.

Treatment Options
If you suspect you have anal fissures, here are some treatment options:
1. Topical Treatments: Over-the-counter creams containing hydrocortisone can help reduce inflammation and pain. Prescription medications like nitroglycerin ointment or calcium channel blockers may also be recommended by a doctor to promote healing.

2. Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help relieve pain and promote healing.

3. Dietary Changes: Increasing fiber intake and hydration can help prevent constipation and reduce straining.

4. Pain Relief: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage discomfort.

5. Surgery: In chronic cases where conservative treatments fail, a surgical procedure may be necessary to relax the anal sphincter and promote healing.

When to See a Doctor
If your symptoms persist despite home treatment, or if you experience severe pain, significant bleeding, or any signs of infection (such as fever or pus), it is essential to consult a healthcare professional. They can provide a thorough examination and recommend appropriate treatments tailored to your condition.

In summary, based on your symptoms, it is plausible that you are experiencing anal fissures. By implementing preventive measures and considering treatment options, you can manage your symptoms effectively. If you have any further concerns or if your condition worsens, please seek medical advice promptly.

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