How to Prevent and Manage Anal Fissures and Related Symptoms

How to improve or prevent anal fissure bleeding?

Hello, Doctor.
(1) A few years ago, I had anal fissures and hemorrhoids and received treatment at the hospital, and I have since recovered.
However, I have noticed that during anal intercourse with my partner, there is a high likelihood of recurrence (almost always), resulting in sharp pain and slight bleeding during bowel movements.
Additionally, there are some transparent white, flaky substances in my stool.
Is this a normal condition? Could this lead to long-term complications? Do you have any recommendations for improving or preventing anal fissures? Are there medications or surgical options available? (2) Additionally, I occasionally experience urgency with bowel movements and urination that I can't control.
Could this be a sign of incontinence? Is there an issue with the sphincter? How can I adjust my habits to improve this? If I go to the hospital, which department should I visit? How should I explain my situation to the doctor?

Niming, 30~39 year old female. Ask Date: 2022/11/15

Dr. Zhang Shuhao reply Surgery

1.
If you have previously experienced anal fissures, it is essential to use ample lubrication and gradually dilate the anus before anal intercourse.
Insertion should only occur when the anal sphincter is completely relaxed.
If you experience sharp pain during the process (the pain from an anal fissure can feel like a cut), it indicates that the wound has not healed.
The presence of translucent white flakes may be related to food or medication.
Conservative treatments include sitz baths and topical medications, as well as measures to prevent constipation.
Some individuals may receive botulinum toxin injections in the sphincter to prevent contraction.
If anal fissures recur or if the same fissure persists for more than eight weeks, surgical intervention to relax the anal sphincter may be recommended.
2.
Young individuals rarely experience functional fecal or urinary incontinence.
Strengthening lower limb exercises and performing squats can enhance pelvic floor muscle strength.
It is advisable to avoid holding urine and not to spend excessive time in the restroom.
If there are concerns, both urology and colorectal clinics offer tests to assess sphincter function; simply discuss your recent symptoms with the physician.

Reply Date: 2022/11/15

More Info

Anal fissures are small tears in the lining of the anus that can cause significant pain, especially during bowel movements. They are often associated with conditions like hemorrhoids and can be exacerbated by certain activities, including anal intercourse. Given your history and current symptoms, it’s essential to address both the management of anal fissures and the potential for related complications.

Understanding Anal Fissures
Anal fissures typically present with sharp pain during and after bowel movements, and they may be accompanied by bleeding. The presence of white, transparent flakes in your stool could indicate mucus, which is not uncommon in individuals with fissures, as the body may produce extra mucus to lubricate the area. However, persistent symptoms warrant a thorough evaluation to rule out other conditions.

Prevention and Management Strategies
1. Dietary Adjustments: A high-fiber diet can help soften stools and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying hydrated by drinking plenty of water is also crucial.

2. Topical Treatments: Over-the-counter creams containing hydrocortisone or topical anesthetics can provide relief. Prescription medications like nitroglycerin ointment or calcium channel blockers (e.g., diltiazem) may help relax the anal sphincter and promote healing.

3. Warm Baths: Soaking in warm water (sitz baths) for 10-15 minutes several times a day can help soothe the area and promote blood flow, aiding in healing.

4. Avoiding Irritants: After bowel movements, gently cleaning the area with water instead of toilet paper can reduce irritation. Avoiding harsh soaps or wipes is also advisable.

5. Anal Intercourse Precautions: If anal intercourse is a trigger for your fissures, consider using plenty of lubricant and ensuring adequate relaxation. Communication with your partner about comfort levels is essential.

6. Medical Interventions: If conservative measures fail, 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.

Potential Complications
Chronic anal fissures can lead to complications such as anal abscesses or fistulas. If left untreated, they may also cause significant discomfort and impact your quality of life. It’s crucial to seek medical advice if symptoms persist or worsen.

Addressing Urinary Symptoms
Regarding your concern about occasional urgency with bowel movements and potential urinary incontinence, this could indicate issues with the pelvic floor or anal sphincter function. Urinary incontinence may arise from various causes, including weakened pelvic muscles or nerve damage.

1. Pelvic Floor Exercises: Kegel exercises can strengthen the pelvic floor muscles, potentially improving both urinary and anal control.
2. Consulting a Specialist: For urinary symptoms, it would be best to consult a urologist or a gastroenterologist who specializes in pelvic floor disorders. When visiting the doctor, explain your symptoms clearly, including the frequency of your issues, any associated pain, and your history of anal fissures.

Conclusion
In summary, managing anal fissures involves a combination of dietary changes, topical treatments, and possibly surgical options if conservative measures fail. It’s essential to address any urinary symptoms with a healthcare provider to rule out underlying conditions. Regular follow-up with your healthcare provider is crucial to monitor your symptoms and adjust treatment as necessary.

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