Anal Fissures: Causes, Symptoms, and Treatment Options

Causes, Symptoms, and Management of Anal Fissures

Hello, doctor.
I usually have a healthy diet, and my bowel movements are mostly normal, but I occasionally experience anal fissures (not often; the last occurrence was two to three months ago).
I have a few questions:
1.
What could be the reason for having anal fissures even though my stools are not particularly hard or large? Could it be due to excessive sphincter muscle tension during bowel movements?
2.
Since I have a regular bowel movement schedule, would taking a muscle relaxant before bowel movements during an acute phase help relax the sphincter muscle?
3.
I feel a sharp pain at only one spot, and it’s not severe (basically, after wiping once or twice, there’s no blood).
However, is it normal to experience a burning sensation around the entire anal area after the next bowel movement?
4.
Do I need to wipe particularly thoroughly? Or is it sufficient to follow my usual routine (toilet paper → bidet → toilet paper)? Does having a slight yellowish residue matter?
5.
Would sitting in a clean basin with warm water help with wound healing and pain relief?

Jiao Lv Da Xue Sheng, 20~29 year old female. Ask Date: 2022/11/24

Dr. Zhang Shuhao reply Surgery

1.
One of the causes of anal fissures is excessive tension in the sphincter muscle, so sphincterotomy can be used as a treatment.
2.
Soaking in warm water and relaxing can be effective; if medication is needed, it is recommended to obtain a prescription from a doctor rather than self-medicating with over-the-counter drugs.
3.
It is normal to rinse with clean water more often to reduce irritation from wiping.
4.
You can use simple ingredient wet wipes or gently pat dry after rinsing with a bidet to avoid excessive wiping.
5.
During the healing period, frequent warm water sitz baths can be beneficial, along with the use of ointments to aid in wound healing.

Reply Date: 2022/11/24

More Info

Anal fissures are small tears in the lining of the anus, often causing pain and discomfort during bowel movements. Understanding the causes, symptoms, and treatment options for anal fissures can help manage and prevent this condition effectively.

1. Causes of Anal Fissures: While you mentioned that your bowel movements are generally normal, there are several factors that can contribute to anal fissures even when stools are not particularly hard or large. One common cause is the excessive tension of the anal sphincter muscles during bowel movements. This can occur if you are straining to pass stool, even if it appears normal. Additionally, factors such as diarrhea, inflammatory bowel disease, or even certain dietary choices (like low fiber intake) can lead to fissures. Stress and anxiety can also increase muscle tension, potentially leading to fissures.

2. Muscle Relaxants: Taking muscle relaxants before bowel movements during an acute phase may help alleviate some discomfort by reducing the tension in the anal sphincter. However, this should be done under the guidance of a healthcare provider. It's essential to address the underlying causes of the fissures, such as ensuring adequate hydration and fiber intake to soften stools and reduce straining.

3. Post-Defecation Discomfort: Experiencing a burning sensation around the anus after a bowel movement is not uncommon, especially if there is a fissure present. This sensation can be due to irritation of the anal tissue or the fissure itself. If the pain is localized and not severe, it may indicate that the fissure is healing. However, if the burning sensation persists or worsens, it may be worth consulting a healthcare provider to rule out other conditions.

4. Hygiene Practices: Maintaining proper hygiene is crucial when dealing with anal fissures. While it is important to clean the area gently, over-scrubbing can irritate the fissure further. Using a combination of toilet paper and a bidet or a gentle rinse with water can be effective. A small amount of residual stool or a yellowish stain is generally not a cause for concern, but it’s essential to ensure that the area is clean to prevent infection.

5. Sitz Baths: Soaking in a warm sitz bath can be beneficial for healing anal fissures. The warm water helps relax the anal sphincter, increases blood flow to the area, and can provide pain relief. It is recommended to sit in warm water for about 10-15 minutes after bowel movements to promote healing and comfort.

In summary, while anal fissures can be uncomfortable and painful, understanding their causes and implementing appropriate treatment strategies can help manage the condition effectively. If you continue to experience fissures or if the symptoms worsen, it is advisable to consult a healthcare provider for further evaluation and treatment options, which may include topical medications, dietary changes, or other interventions.

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