Are Ulcers the Same as Anal Fissures? Your Symptoms

Is an ulcer the same as an anal fissure?

I have irritable bowel syndrome with frequent diarrhea.
Recently, for over a month, I've experienced some pain after using the restroom.
I used a suppository for nearly a month, thinking it had improved, but then the pain became noticeable when sitting on harder chairs.
I visited two hospitals; the first one said there were no issues internally.
At the second hospital, the doctor noted discomfort specifically at the 12 o'clock position during the examination, but it wasn't the same pain as when sitting on a hard chair.
Upon closer inspection, I realized the pain was localized there, and I had assumed it was deeper, which is why I kept using the suppository.
The doctor asked if an ulcer is the same as an anal fissure.
After the examination, it was found that a previously mild ulcer had not fully healed, and it was not deep inside but rather near the outer area.
The doctor prescribed a topical hemorrhoid cream to apply externally around the anal area, stating that the suppository was not very helpful.
Since the pain only occurs occasionally when sitting on hard chairs, I wonder if I should continue applying the cream until it's finished, or if I should only apply it when the pain recurs.
I am also taking medication for irritable bowel syndrome, which has helped reduce the diarrhea, but I still experience two to three bowel movements concentrated in the morning until noon.

Kunrao Zhong, 40~49 year old female. Ask Date: 2022/06/24

Dr. Ke Fangxu reply Surgery

Anal fissures can present with ulcerative lesions, but the presence of an ulcer does not necessarily indicate an anal fissure.
Your condition is likely caused by a localized issue leading to anal trauma.
You can apply ointment inside the affected area; it is acceptable to apply it when there is pain, and you can use it both in the morning and at night.

Reply Date: 2022/06/24

More Info

When discussing the differences between anal ulcers and anal fissures, it is essential to understand the definitions, symptoms, and treatment options for each condition.
Anal Fissures are small tears in the lining of the anus, often caused by trauma during bowel movements, particularly when passing hard stools. Symptoms typically include sharp pain during and after bowel movements, which may last for several minutes to hours. Patients may also notice blood on the toilet paper or in the stool. Anal fissures can be acute (recently developed) or chronic (long-lasting), and they are often associated with conditions like constipation or diarrhea.

Anal Ulcers, on the other hand, refer to deeper lesions that can occur in the anal canal or surrounding areas. They may be caused by various factors, including inflammatory bowel diseases (like Crohn's disease or ulcerative colitis), infections, or malignancies. Symptoms of anal ulcers can include persistent pain, discomfort, and possible bleeding, but they may not always be associated with bowel movements.
In your case, you mentioned experiencing pain after bowel movements and discomfort when sitting on hard surfaces. This could suggest the presence of an anal fissure, especially if the pain is sharp and associated with bowel movements. The fact that you have a history of irritable bowel syndrome (IBS) and diarrhea could contribute to the development of fissures due to frequent straining or passing of loose stools.

Regarding your treatment, the use of topical medications like the ointment prescribed (平痔隆) is appropriate for managing symptoms associated with anal fissures. These medications can help soothe the area, promote healing, and reduce pain. It is generally advisable to continue using the ointment until the symptoms resolve, even if you feel some relief. If the pain returns, you can apply the ointment again as needed.
You also mentioned using suppositories, which may not have provided significant relief. Suppositories can be beneficial for certain conditions, but they may not be as effective for fissures, especially if the fissure is located near the external anal area.
It is crucial to maintain a healthy diet to avoid constipation and straining during bowel movements. Increasing fiber intake, staying hydrated, and possibly using stool softeners can help manage your bowel habits.
If your symptoms persist despite treatment, or if you notice any changes such as increased pain, bleeding, or changes in bowel habits, it is essential to follow up with your healthcare provider. They may consider further evaluation, including a physical examination or additional diagnostic tests, to rule out other potential causes of your symptoms.

In summary, while anal ulcers and fissures are related, they are distinct conditions with different causes and treatment approaches. Your symptoms seem to align more closely with anal fissures, particularly given your history of IBS and the nature of your pain. Continuing your prescribed treatment and monitoring your symptoms will be key to managing your condition effectively.

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