Managing Pain from Anal Fissures and Hemorrhoids: Effective Treatments

Irritable bowel syndrome, anal fissures, and hemorrhoid ointment?

I have been using hemorrhoid cream for 5 months due to anal fissures, and now the protective layer around my anus (hemorrhoids) is gone.
I experience pain in my buttocks when riding a motorcycle or bicycle, and I'm unsure how to address this issue.
Thank you, doctor.

Re ai da hai, 50~59 year old female. Ask Date: 2022/09/20

Dr. Zhang Shuhao reply Surgery

It may be caused by excessive use of steroid-containing ointments.
First, stop using hemorrhoid treatments and avoid excessive cleaning of the anal and perineal area.
You can use simple moisturizing products such as lotions.
If symptoms do not improve, you should visit a dermatologist or a colorectal specialist for examination and medication treatment.

Reply Date: 2022/09/20

More Info

Managing pain from anal fissures and hemorrhoids can be quite challenging, especially when symptoms persist despite ongoing treatment. Anal fissures are small tears in the lining of the anus, often caused by passing hard stools, while hemorrhoids are swollen veins in the rectal area that can cause discomfort and pain. Both conditions can lead to significant discomfort, particularly during activities like cycling or sitting for extended periods.

Effective Treatments for Anal Fissures and Hemorrhoids
1. Topical Treatments:
- Hydrocortisone Cream: This can help reduce inflammation and itching associated with hemorrhoids. It’s important to use it as directed to avoid skin thinning.

- Numbing Creams: Over-the-counter creams containing lidocaine can provide temporary relief from pain and discomfort.

- Anal Fissure Creams: Products specifically designed for fissures, often containing nitroglycerin or calcium channel blockers, can help relax the anal sphincter and promote healing.

2. Sitz Baths: Soaking in warm water several times a day can help soothe the area, reduce pain, and promote healing. This is especially beneficial after bowel movements.

3. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements, which is crucial for healing fissures and preventing hemorrhoids. Foods high in fiber include fruits, vegetables, whole grains, and legumes. Additionally, staying well-hydrated is essential.

4. Oral Medications:
- Pain Relievers: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain.

- Laxatives: If constipation is an issue, gentle laxatives or stool softeners can help ease bowel movements.

5. Physical Therapy: In some cases, pelvic floor physical therapy may be beneficial. A physical therapist can provide exercises and techniques to help relax the pelvic floor muscles, which can alleviate pain and improve bowel function.

6. Surgical Options: If conservative treatments fail, surgical options may be considered. For fissures, a lateral internal sphincterotomy can be performed to relieve tension in the anal sphincter. For hemorrhoids, procedures such as rubber band ligation or hemorrhoidectomy may be necessary.

7. Avoiding Irritants: It’s important to avoid harsh soaps or wipes in the anal area, as these can exacerbate irritation. Instead, gentle cleansing with water and mild soap is recommended.

8. Lifestyle Modifications:
- Avoid Prolonged Sitting: If cycling or sitting for long periods exacerbates your pain, consider taking breaks to stand or walk around.

- Wear Loose Clothing: Tight clothing can increase discomfort; wearing loose-fitting garments can help alleviate pressure on the anal area.

Conclusion
If you have been using hemorrhoid creams for five months without improvement, it may be time to consult with a healthcare provider for a comprehensive evaluation. They can assess the severity of your condition and recommend a tailored treatment plan. Persistent pain may indicate the need for more aggressive interventions or a reassessment of your current treatment strategy. Remember, managing anal fissures and hemorrhoids often requires a multifaceted approach, combining topical treatments, lifestyle changes, and possibly medical procedures to achieve the best outcomes.

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