Anal Fissures: Causes, Treatments, and Relief Tips

Anal fissure issues?

Hello, doctor.
I have had an anal fissure for the past few days and have several questions:
1.
What could be the reason for developing an anal fissure even though my stool is not particularly hard or large? Could it be due to excessive sphincter muscle tension during bowel movements? How can I relax the anal sphincter?
2.
What could be the possible reasons for having a hard front end of the stool but a smooth back end, and how can I improve this?
3.
Since I have a regular bowel schedule, would taking a muscle relaxant before bowel movements during the acute phase help relax the sphincter?
4.
Is it necessary to wipe completely clean after a bowel movement? Does having a slight yellow residue matter?
5.
Under conditions of balanced nutrition, would slightly reducing food intake and avoiding snacks outside of regular meals help lessen the burden on the anus?
6.
During the acute phase of an anal fissure, even though bowel movements are painful, is it still advisable to maintain a normal frequency of bowel movements and respond to the urge to go, to avoid a vicious cycle of harder stools?
7.
Is it safe to take magnesium oxide (MgO) as a stool softener during the acute phase? In the past, my doctor prescribed this for me to alleviate symptoms related to anal fissures or hemorrhoids.

8.
I am unclear about when to take MgO as a stool softener—should it be taken before meals, with meals, or after meals? The instructions state to take it before or with meals when used as a laxative; does "laxative" refer to stool softeners in this context?
I have many questions, but I am quite anxious.
Thank you for your guidance!

Jiao Lü de Yao Xue Xi Xue Sheng, 20~29 year old female. Ask Date: 2022/11/25

Dr. Chen Bingze reply Surgery

Hello, I understand this issue must be very troubling for you.

1.
Typically, increased anal sphincter pressure is a concern.
It is recommended to take a warm sitz bath for fifteen minutes daily.

2.
If the stool is hard and bulky, it may be difficult to pass.
Increasing your water intake and consuming more fruits and vegetables can help.
If you are experiencing discomfort during an acute phase of anal fissure, you can insert a hemorrhoid suppository before bowel movements to provide lubrication at the anal opening.

3.
Muscle relaxants do not effectively relax the anal sphincter.
It is advisable to drink more water and eat more fruits and vegetables.
If you are uncomfortable during the acute phase of an anal fissure, inserting a hemorrhoid suppository before bowel movements can help lubricate the anal opening.

4.
You might consider using a bidet or a toilet with a bidet attachment.

5.
That’s not possible.

6.
You are correct; it is important to maintain regular bowel habits.
If you are experiencing discomfort during the acute phase of an anal fissure, inserting a hemorrhoid suppository before bowel movements can help lubricate the anal opening.

7.
Yes, taking magnesium oxide (MgO) can help soften the stool.

8.
MgO is both a gastric medication and a stool softener.
You can take it according to the instructions on the package.
Laxatives are indeed stool softeners.

In summary, I recommend taking MgO daily, inserting a suppository before bowel movements, and soaking your buttocks in warm water for fifteen minutes each day.
This should yield good results.

Reply Date: 2022/11/25

More Info

Anal fissures are small tears in the lining of the anus that can cause significant pain and discomfort, especially during bowel movements. Understanding the causes, treatments, and relief tips for anal fissures can help manage symptoms and promote healing. Here are answers to your questions:
1. Causes of Anal Fissures: Even if your stool is not particularly hard, fissures can occur due to excessive tension in the anal sphincter during bowel movements. This tension can be caused by straining, which may happen even with softer stools if you are pushing too hard. To relax the anal sphincter, consider practicing deep breathing exercises, warm sitz baths, or using a topical anesthetic to numb the area before a bowel movement.

2. Bowel Movement Characteristics: If the front of your stool is hard while the rest is smooth, it may indicate that you are experiencing a form of constipation or that your diet lacks sufficient fiber. To improve this, increase your intake of fiber-rich foods such as fruits, vegetables, and whole grains. Staying hydrated is also crucial, as it helps soften the stool.

3. Muscle Relaxants: Taking a muscle relaxant before bowel movements during the acute phase of a fissure may help reduce the tension in the anal sphincter, potentially making bowel movements less painful. However, it is essential to consult with your healthcare provider before starting any medication to ensure it is appropriate for your situation.

4. Hygiene Practices: It is important to maintain good hygiene after bowel movements. While it is ideal to clean the area thoroughly, a small amount of residual stool (like a faint yellow stain) is usually not a cause for concern. However, ensure that you are not using harsh soaps or wipes that can irritate the area further.

5. Dietary Adjustments: Slightly reducing your food intake and avoiding snacks between meals can help decrease the burden on your digestive system. However, it is essential to maintain a balanced diet to ensure you are still getting enough nutrients and fiber to prevent constipation.

6. Maintaining Regular Bowel Movements: It is crucial to maintain a regular bowel movement schedule, even during the acute phase of a fissure. Ignoring the urge to go can lead to harder stools, worsening the fissure. If you feel the urge, try to go to the bathroom as soon as possible to avoid straining.

7. Using Magnesium Oxide (MgO): Magnesium oxide can be an effective stool softener during the acute phase of a fissure. It helps draw water into the intestines, making stools softer and easier to pass.
8. Timing of MgO Intake: When using magnesium oxide as a stool softener, it is typically recommended to take it with food to minimize gastrointestinal discomfort. The term "laxative" refers to substances that promote bowel movements, which can include both stimulant laxatives and stool softeners. In your case, MgO is being used as a stool softener, so taking it with meals is appropriate.

In summary, managing anal fissures involves a combination of dietary adjustments, maintaining regular bowel habits, and possibly using medications to relieve symptoms. If your symptoms persist or worsen, it is essential to consult with a healthcare provider for further evaluation and treatment options. Remember, maintaining a relaxed state during bowel movements and ensuring proper hydration and fiber intake can significantly aid in the healing process.

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