Anal Fissures: Symptoms, Treatment, and Surgical Options

Anal fissure issues?

Hello, Doctor! I would like to ask the following questions:
1.
I have had an anal fissure for several months, and after a hospital examination, it was determined to be a fresh wound.
Does this not count as chronic? (I have been doing sitz baths and using suppositories, but I still experience pain shortly after bathing.)
2.
Can an anal fissure cause frequent sensations of urgency? Or is it possible for the anal area to feel moist? When I feel the urge to defecate, there is some moisture, but it disappears when the urge subsides.
What could be the reason for this?
3.
If the fissure does not heal, what defines a chronic anal fissure? Is it based on a duration of several months, or are there specific conditions that qualify? If there are multiple fissures but they are still considered fresh wounds, do they still count? Currently, I have not experienced any sentinel piles.

4.
In addition to pain during bowel movements, I also experience pain near the surrounding muscles.
Why is this happening? (This is almost always the case for me.)
5.
If surgery is performed, will the anal opening be sutured? Will I need to change dressings postoperatively?
6.
When there is no wound and the stool is formed, I have to exert a little during bowel movements, going two to three times a day.
Now, even slight exertion causes pain, and if I don’t exert myself, the stool becomes watery and is still very painful.
If I try to go two to three times a day like before, I can't help but take gastrointestinal medication...

7.
When the wound is painful, I feel an increasing tightness, and the pain worsens during anal contraction.
If sitz baths are inconvenient, how can I relieve this? Using suppositories gives me a sense of urgency, and applying ointment is uncomfortable for the skin.

8.
Under what circumstances is surgery not advisable? I see many people suffering for several years...

Thank you for your assistance!

TED, 50~59 year old female. Ask Date: 2023/04/27

Dr. Ke Fangxu reply Surgery

1.
It is also possible to have a chronic anal fissure combined with an acute wound.

2.
The irritation from the anal fissure may trigger the urge to defecate, and this urge can cause relaxation of the anal sphincter, leading to moisture, which is a normal phenomenon.

3.
As you mentioned, if it has been several months, it is indeed a chronic anal fissure; the acute wound is caused by the repeated tearing of the chronic fissure.

4.
Chronic anal fissures can potentially cause surrounding pain.

5.
Surgery typically does not involve suturing, depending on the severity; dressings may not be necessary, but sitz baths are recommended.

6.
Excessive bowel movements can be a cause of anal fissures.

7.
Pain relief medications may be prescribed.

8.
If it affects daily life, surgery may be recommended.

Reply Date: 2023/04/27

More Info

Anal fissures are painful tears in the lining of the anal canal, often caused by trauma during bowel movements, particularly when passing hard stools. Understanding the symptoms, treatment options, and potential surgical interventions is crucial for managing this condition effectively.

1. Acute vs. Chronic Fissures: A fissure is considered acute if it has been present for less than six weeks. If your doctor has indicated that your fissure is a "fresh wound," it suggests that it is still in the acute phase. However, if you have been experiencing symptoms for several months, it may be transitioning into a chronic fissure, especially if the pain persists despite treatment. Chronic fissures often exhibit more severe symptoms and may require different management strategies.

2. Symptoms and Sensations: It is not uncommon for individuals with anal fissures to experience a sensation of urgency or frequent urges to defecate. This can be due to the irritation of the anal canal and surrounding tissues. The moist feeling you describe may also be related to increased anal sphincter tension or inflammation in the area. If you notice that the sensation of urgency correlates with pain or discomfort, it may be a sign that your body is reacting to the fissure.

3. Chronic Fissures: A fissure is typically classified as chronic if it lasts longer than six weeks. However, even if the fissure appears fresh, if it keeps recurring or if you have persistent symptoms, it may be considered chronic. The presence of sentinel piles (or sentinel tags) can also indicate a chronic fissure. If you have been experiencing recurrent fissures despite treatment, it is essential to discuss this with your healthcare provider.

4. Pain Beyond Bowel Movements: Experiencing pain in the muscles surrounding the anal area, even when not having a bowel movement, can occur due to muscle tension or spasms in the anal sphincter. This tension can be a response to the pain from the fissure itself, leading to a cycle of discomfort. Relaxation techniques, warm sitz baths, and topical treatments may help alleviate some of this discomfort.

5. Surgical Options: If conservative treatments fail, surgical options may be considered. The most common procedure is lateral internal sphincterotomy, where a portion of the anal sphincter muscle is cut to relieve tension and promote healing. Post-operative care typically involves keeping the area clean, using topical medications, and possibly changing dressings, depending on the surgical approach.

6. Bowel Movements and Pain: It is crucial to maintain soft stools to minimize pain during bowel movements. If you find that you need to exert effort to pass stools, this can exacerbate the fissure. A high-fiber diet, adequate hydration, and possibly stool softeners can help. If you are experiencing pain with even slight exertion, it may be beneficial to consult your doctor about adjusting your treatment plan.

7. Managing Pain and Tension: If sitz baths are not feasible, consider using a warm compress on the area to help relax the muscles and alleviate pain. Over-the-counter topical anesthetics may also provide temporary relief. If you find that using suppositories increases your urge to defecate, discuss alternative treatments with your healthcare provider.

8. Surgical Considerations: Surgery may not be suitable for everyone. Factors such as the presence of other medical conditions, the severity of the fissure, and the patient's overall health will influence the decision. If you have had fissures for years without improvement, it is essential to have a thorough discussion with your healthcare provider about the risks and benefits of surgery.

In conclusion, managing anal fissures requires a comprehensive approach that includes dietary modifications, topical treatments, and possibly surgical interventions if conservative measures fail. Regular follow-up with your healthcare provider is essential to monitor your condition and adjust treatment as necessary. If you have ongoing pain or concerns, do not hesitate to seek further medical advice.

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