Anal Itching and Fissures: Causes and Solutions

Anal itching and anal fissure?

About 12 days ago, I experienced itching in the anal area almost every day (especially more frequently at night).
Then, starting around May 2nd, I began to feel pain in the anus when having a bowel movement, which feels like an anal fissure.
I looked online and found that the common causes of anal fissures are usually hard stools, but diarrhea, frequent bowel movements, or holding in the urge to defecate for a long time can also lead to fissures.
My bowel movements are quite regular, but I still feel a tearing sensation in the anus when passing stool.
I would like to know why I still have anal fissures even though my bowel movements are smooth.
Should I see a doctor? Recently, I have been feeling anxious about using the restroom and have purchased an anal suppository (Boshizheng), but it doesn't seem to help with the fissure, as I still experience tearing sensations when using the bathroom.
Thank you.

Ping An, 30~39 year old female. Ask Date: 2023/05/06

Dr. Ke Fangxu reply Surgery

Excessive pressure in the anal sphincter can also be one of the causes of anal fissures; however, a medical examination is necessary to confirm this, as it may not be an issue related to anal fissures at all.
It is advisable to start with warm sitz baths along with topical medications for treatment.
If there is no improvement, it is best to consult a physician for a more thorough evaluation.

Reply Date: 2023/05/06

More Info

Anal itching and fissures can be quite uncomfortable and distressing, and understanding their causes and potential solutions is crucial for effective management. Based on your description, it seems you are experiencing anal itching that has progressed to pain during bowel movements, which may indicate the presence of an anal fissure.

Causes of Anal Itching and Fissures
1. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. However, as you mentioned, even with regular bowel movements, fissures can occur due to other factors such as:
- Chronic Diarrhea: Frequent loose stools can irritate the anal area.

- Straining: Even if your stools are soft, straining during bowel movements can lead to fissures.

- Inflammation: Conditions like inflammatory bowel disease (IBD) or infections can contribute to fissure formation.

- Skin Conditions: Eczema or psoriasis can cause itching and irritation around the anal area.

2. Itching: Anal itching (pruritus ani) can be caused by:
- Hygiene Issues: Inadequate cleaning after bowel movements or excessive cleaning can both lead to irritation.

- Diet: Certain foods, such as spicy foods, caffeine, or alcohol, can irritate the anal area.

- Infections: Fungal infections or sexually transmitted infections can also cause itching.

- Hemorrhoids: Swollen veins in the rectal area can lead to discomfort and itching.

Solutions and Management
1. Dietary Changes: Ensure you are consuming a high-fiber diet to promote softer stools. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also essential.

2. Over-the-Counter Treatments: While you mentioned using an anal suppository, consider topical treatments that contain hydrocortisone or lidocaine to reduce inflammation and pain. These can provide temporary relief.

3. Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the area and promote healing.

4. Avoid Straining: When you feel the urge to go, try not to delay. If you find yourself straining, consider using a stool softener or a fiber supplement to ease the process.

5. Hygiene Practices: Maintain good hygiene by gently cleaning the anal area with mild soap and water. Avoid using harsh soaps or wipes that contain alcohol or fragrances, as these can exacerbate irritation.

6. Medical Consultation: Given that you are experiencing pain during bowel movements and have concerns about an anal fissure, it is advisable to consult a healthcare provider. They can perform a physical examination to confirm the presence of a fissure and rule out other conditions. If a fissure is diagnosed, they may recommend treatments such as topical nitroglycerin, calcium channel blockers, or even surgical options in more severe cases.

7. Addressing Anxiety: It’s understandable to feel anxious about bowel movements if you are experiencing pain. Discussing your fears with a healthcare provider can help alleviate anxiety and provide strategies for coping.

In summary, while anal fissures can occur even with regular bowel movements, addressing the underlying causes and implementing appropriate management strategies can significantly improve your symptoms. If self-care measures do not provide relief, seeking medical advice is essential for proper diagnosis and treatment.

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