Chronic Anal Fissures: Pain Management and Healing Options

Issues with anal fissures lasting over two months?

For the past two months, I have experienced pain every time I use the restroom.
I have tried soaking in warm water and using topical ointments and suppositories, and I have been mindful of my diet, with no issues of constipation.
I typically go to the bathroom about 2 to 3 times a day, and the pain lasts for a long time.
The injury is internal, not external, and sitting is uncomfortable as well.
During my most recent visit to the doctor, I was informed that there is a significant amount of scar tissue inside, and some areas are healing.
At that moment, I felt like the situation was serious.
I had previously read that "if scar tissue forms, it equates to fibrosis, which is difficult to heal and can cause ongoing pain due to the pulling of the wound; only surgery can truly resolve it." However, the doctor in the clinic mentioned that it can still heal completely on its own and that the scar tissue will gradually diminish.
I am unsure which statement is correct or if I have misunderstood the relationship between scar tissue and fibrosis.
Additionally, since sitting causes pain, does that indicate that pressure is irritating the wound? Should I avoid any stimulation (like sitting)? However, it is impossible to avoid sitting altogether, and I really don't know how to escape this pain.

Ganglie liang ge yue, 40~49 year old female. Ask Date: 2022/07/20

Dr. Ke Fangxu reply Surgery

The typical symptoms of an 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 is to address the bowel movement issues, along with warm sitz baths.
Warm sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
Over-the-counter hemorrhoid suppositories can also be used.
If the wound heals gradually, it will naturally resolve.
However, if bowel issues persist and prevent the wound from healing, it may evolve into a chronic anal fissure.
Therefore, both statements are correct.
If symptoms continue without improvement, it is advisable to consult a physician for evaluation.

Reply Date: 2022/07/20

More Info

Chronic anal fissures can be a painful and distressing condition, significantly impacting your quality of life. Understanding the nature of these fissures, their healing process, and pain management options is crucial for effective treatment.

Anal fissures are small tears in the lining of the anal canal, often caused by trauma during bowel movements, particularly when passing hard stools. Chronic fissures, which last longer than eight weeks, can develop scar tissue, making healing more complicated. The presence of scar tissue does not necessarily mean that the fissure cannot heal; however, it can lead to increased pain and discomfort due to the sensitivity of the area.

In your case, it seems that you have been experiencing significant pain during bowel movements despite taking measures such as warm baths and using topical medications. The fact that your doctor noted the presence of scar tissue and partial healing suggests that while some progress has been made, the fissure has not fully resolved. This can lead to a cycle of pain and further irritation, especially if the area is subjected to pressure or friction, such as when sitting.

The concern regarding scar tissue and fibrosis is valid. Scar tissue can indeed make healing more challenging, as it may not have the same elasticity or blood supply as healthy tissue. However, many patients with chronic fissures can still achieve healing without surgery, especially if they adhere to a comprehensive treatment plan. This plan may include:
1. Dietary Modifications: Ensuring a high-fiber diet can help soften stools and reduce straining during bowel movements. Staying well-hydrated is also essential.

2. Topical Treatments: Medications such as nitroglycerin ointment or calcium channel blockers can help relax the anal sphincter, increasing blood flow to the area and promoting healing. Your doctor may also recommend topical anesthetics to alleviate pain.

3. Warm Sitz Baths: Continuing to soak in warm water can help soothe the area and promote relaxation of the anal sphincter, which may reduce pain during bowel movements.

4. Avoiding Strain: It’s crucial to avoid straining during bowel movements. If you feel the urge to go, try to respond promptly rather than holding it in, which can lead to harder stools.

5. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage discomfort. However, consult your doctor before starting any new medication.

6. Surgical Options: If conservative measures fail and the fissure remains chronic, surgical options such as lateral internal sphincterotomy may be considered. This procedure involves cutting a small portion of the anal sphincter to relieve tension and promote healing.

Regarding your concern about sitting, it is indeed possible that pressure on the area exacerbates your pain. If sitting is uncomfortable, consider using a cushion or a specialized seat that relieves pressure on the anal area. Additionally, try to alternate between sitting and standing or lying down to minimize discomfort.

In summary, while scar tissue can complicate the healing of chronic anal fissures, it does not preclude the possibility of complete recovery. A combination of dietary changes, topical treatments, and pain management strategies can significantly improve your symptoms. If conservative measures do not lead to improvement, discussing surgical options with your healthcare provider may be warranted. Always follow your doctor's advice and keep them informed of any changes in your condition.

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