Anal Fissures and Polyps: Concerns and Care

Anal fissures and polyps that do not heal?

A month ago, I noticed some blood after having a bowel movement.
Although it was only a drop or two, I was very worried and decided to see a doctor.
During the examination, the doctor said that there was nothing unusual on the exterior of my anus.
After a digital rectal exam, he diagnosed me with a grade one internal hemorrhoid and an anal fissure, along with a small wound and a small polyp.
He mentioned that it was a mild condition and that using an ointment would help.
At that time, I was so concerned that I only asked about the healing of the anal fissure and forgot to inquire about the polyp.
Later, I looked it up online and was alarmed to read that polyps could potentially become cancerous or lead to external hemorrhoids.

Currently, my bowel movements have become smoother and there is no blood, but I still experience some swelling and a slight pain in the anal area after each bowel movement, which lasts for several hours.
The small polyp is still present, and I suspect it may have grown larger since it is located slightly inside the anal opening, making it difficult for me to confirm by looking in the mirror.
I am worried that it may not improve and could even worsen.

I would like to ask the doctor: Can a small polyp become cancerous or lead to external hemorrhoids? Will the small polyp always be there, or is there a possibility that it could shrink or disappear? Even if my bowel movements are smooth, can the small polyp still gradually increase in size? Is the swelling and pain I experience after each bowel movement due to the small polyp or the wound from the anal fissure? How should I care for myself? I am currently afraid to sit down.
Thank you, doctor.

Donky, 20~29 year old female. Ask Date: 2023/04/23

Dr. Zhang Shuhao reply Surgery

Polyps can develop into cancer, specifically referring to adenomatous polyps that form in the colorectal mucosa, which is why they are typically removed upon detection.
Recurrent anal fissures are often accompanied by sentinel piles on the lateral side of the anus and hypertrophic papillae on the inner side, resulting from repeated injury and healing at the site of the fissure.
These appear as soft tissue protrusions but are not the same as the colorectal polyps that are commonly associated with cancer, so there is no need for excessive concern.
If anal fissures recur, in addition to dietary changes, medications, lifestyle adjustments, and warm sitz baths, surgical intervention to relax the anal sphincter may be considered, although it is recommended to try conservative treatments first.

Reply Date: 2023/04/23

More Info

Understanding anal fissures and polyps is crucial for managing your health and alleviating concerns. Based on your description, it sounds like you've been experiencing some discomfort related to a grade one internal hemorrhoid, an anal fissure, and a small polyp. Let's break down these conditions and address your concerns.

Anal Fissures
An anal fissure is a small tear in the lining of the anus, often caused by passing hard stools or straining during bowel movements. Symptoms typically include sharp pain during and after bowel movements, and sometimes bleeding. The good news is that many fissures heal on their own with conservative treatment, which may include topical medications, dietary changes to soften stools, and increased hydration.

Polyps
Polyps are growths on the lining of the colon or rectum. While most polyps are benign, some can develop into cancer over time, particularly if they are adenomatous polyps. However, the risk of a small polyp turning cancerous is generally low, especially if it is small and asymptomatic. Regular monitoring and follow-up with your healthcare provider are essential for managing any potential risks.

Concerns About Your Symptoms
1. Will the small polyp turn into cancer or an external hemorrhoid?
- The likelihood of a small polyp turning into cancer is generally low, especially if it is small and has not shown any concerning features. However, it is essential to have regular check-ups to monitor its size and any changes. External hemorrhoids are different from polyps; they are swollen veins that can develop outside the anus and are not directly related to polyps.

2. Will the small polyp remain, shrink, or disappear?
- Small polyps can sometimes remain stable, shrink, or even disappear, but this is not guaranteed. Regular monitoring is key. If your healthcare provider has recommended a follow-up, it’s important to adhere to that schedule.

3. Is the post-bowel movement swelling and pain due to the polyp or the fissure?
- The discomfort you feel after bowel movements could be attributed to both the anal fissure and the small polyp. The fissure can cause sharp pain and swelling, while the presence of a polyp may contribute to discomfort as well.

Care and Management
To manage your symptoms effectively, consider the following:
- Dietary Changes: Increase fiber intake through fruits, vegetables, and whole grains to soften stools and reduce straining during bowel movements.

- Hydration: Drink plenty of water to help keep stools soft.

- Topical Treatments: Continue using any prescribed topical medications to promote healing of the fissure and reduce discomfort.

- Warm Baths: Soaking in warm water can help relieve pain and promote healing.

- Avoid Straining: Try not to strain during bowel movements, as this can exacerbate fissures and hemorrhoids.

- Follow-Up: Schedule regular check-ups with your healthcare provider to monitor the polyp and ensure that the fissure is healing properly.

When to Seek Further Care
If you notice any changes in the size of the polyp, experience increased pain, or see any new symptoms such as significant bleeding or changes in bowel habits, it’s essential to contact your healthcare provider promptly.

In conclusion, while it’s understandable to be concerned about your symptoms, many anal fissures and small polyps can be managed effectively with appropriate care. Regular follow-ups with your healthcare provider will help ensure that any potential issues are addressed early on. Remember to take care of your overall health through diet, hydration, and proper bowel habits to support healing and prevent recurrence.

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