Anal Fissures: Symptoms, Causes, and Treatment Options

Anal fissure issues?

Hello Doctor: Two days ago, I experienced a tearing sensation on the right side of my anus while having a bowel movement, possibly due to hard stool.
It wasn't very painful, but there was a noticeable feeling of a tear.
Afterward, there seemed to be blood clots in the toilet (it was just at the end of my menstrual period, so it shouldn't be from the endometrium).
Since then, I have had a persistent burning sensation in my anus.
The next day, my stool was soft, so there was no pain during the process, but I felt a sharp pain when the stool exited the anus, as if it were touching a wound.
Today, I continue to experience periodic burning and mild pain, which I did not have before that bowel movement.
I have the following questions for you: 1.
Could these symptoms indicate an anal fissure? 2.
On the day of the painful bowel movement, I had a doctor examine me for external hemorrhoids, and they said there was no issue, so can we rule out other infectious diseases? 3.
Since I am sensitive to steroids, is it appropriate for me to use the hemorrhoid suppository and ointment, which I heard do not contain steroids? Thank you for taking the time to answer my questions, Doctor!

Jin, 20~29 year old female. Ask Date: 2023/06/10

Dr. Ke Fangxu reply Surgery

1.
Based on your description, it seems somewhat similar, but a physical examination is necessary to confirm whether it is an anal fissure.

2.
The absence of infection two days ago does not rule out the possibility of an infection now, so this cannot be dismissed.

3.
According to the manufacturer's indicated ingredients, only sodium oleate is permissible for use.

Reply Date: 2023/06/10

More Info

Anal fissures are small tears in the lining of the anus, often caused by passing hard stools, which can lead to significant discomfort and pain during bowel movements. Based on your description, it does seem likely that you are experiencing symptoms consistent with an anal fissure. Let’s break down your questions and provide some insights into the condition, its causes, symptoms, and treatment options.

1. Are these symptoms indicative of an anal fissure?
Yes, the symptoms you describe—specifically the tearing sensation during bowel movements, the presence of blood, and the burning sensation afterward—are characteristic of an anal fissure. The fact that you experienced pain during the passage of a hard stool, followed by a sensation of a tear, aligns well with this diagnosis. Anal fissures can cause sharp pain during bowel movements and a lingering burning sensation afterward, which can last for several hours.

2. Can other conditions be ruled out?
Since you mentioned that a doctor examined you for external hemorrhoids and found no issues, it is reasonable to consider that other conditions such as infections or more serious diseases are less likely. However, it is important to note that while external hemorrhoids can cause similar symptoms, they are distinct from anal fissures. If the symptoms persist or worsen, further evaluation may be warranted to rule out other conditions, including infections or inflammatory diseases.

3. Is the use of non-steroidal treatments appropriate?
Given your sensitivity to steroids, using a non-steroidal topical treatment like the one you mentioned (益痔康栓劑) is a suitable choice. These types of medications can help soothe the area and promote healing without the potential side effects associated with steroid use. It’s important to maintain good hygiene and consider dietary changes to ensure softer stools, which can help prevent further irritation and allow the fissure to heal.

Additional Considerations and Treatment Options
- Dietary Changes: Increasing your fiber intake can help soften your stools, making bowel movements easier and less painful. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Additionally, staying well-hydrated is crucial.

- Sitz Baths: Taking warm sitz baths can provide relief from pain and discomfort. Soaking the anal area in warm water for about 10-15 minutes several times a day can help relax the muscles and promote healing.

- Topical Treatments: In addition to the non-steroidal ointments, over-the-counter creams containing lidocaine can help numb the area and provide temporary relief from pain.

- Medications: If the pain is significant, your doctor may recommend oral pain relievers such as acetaminophen or ibuprofen.

- Follow-Up: If your symptoms do not improve within a week or two, or if they worsen, it is essential to follow up with your healthcare provider. Persistent fissures may require more advanced treatments, such as prescription medications or, in rare cases, surgical intervention.

In summary, based on your symptoms, it does appear that you are dealing with an anal fissure. Implementing dietary changes, using appropriate topical treatments, and maintaining good hygiene can significantly aid in healing. However, if symptoms persist, further evaluation by a healthcare professional is recommended. Always consult with your doctor before starting any new treatment to ensure it is appropriate for your specific situation.

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