Chronic and Acute Anal Fissures: A Patient's Guide

Anal fissure issues?

Hello Dr.
Chang,
On July 7th, I experienced an anal fissure after a hard bowel movement.
During this time, I took sitz baths for 10 minutes in the morning and evening.
After more than a week, I was able to pass stool without pain.
However, after a forceful bowel movement on July 24th, the fissure reopened, and the symptoms have persisted until today.
The pain during bowel movements is manageable, with only a slight tearing sensation, but standing up afterward causes significant pain due to muscle pressure on the wound.
I also have a grade III mixed hemorrhoid located posteriorly on the left side of the anus, which protrudes after bowel movements.
I would like to ask the doctor:
1.
Does this condition qualify as a chronic anal fissure, or is it an acute anal fissure that reopened during the healing phase?
2.
Will the prolapse of the mixed hemorrhoid hinder the healing of the anal fissure?
3.
Which ointment is more suitable for use, zinc oxide ointment or a hemorrhoid relief ointment?
4.
I can faintly see the wound externally (it appears somewhat deep); should I apply the ointment internally as well (I am concerned about scratching the anus with my nails)?
5.
Generally, how long does it take for a deep anal fissure to heal?
Thank you, Dr.
Chang.

Huang, 20~29 year old female. Ask Date: 2023/07/28

Dr. Zhang Shuhao reply Surgery

1.
Chronic anal fissure is defined as a wound that persists for more than eight weeks, typically associated with increased anal sphincter tone and a deeper wound.
Based on your description, it is still possible that it is an acute anal fissure.

2.
Mixed hemorrhoid prolapse does not hinder the healing of anal fissures, but it is important to avoid prolonged sitting on the toilet and excessive straining.

3.
The Lehuzi ointment has better analgesic effects, but long-term use is not recommended.
If used for more than two weeks, it is advisable to take a break for a few days to prevent skin sensitivity.

4.
When applying ointments into the anus, it is recommended to insert only up to half a fingertip deep.
To avoid scratching with nails, a cotton swab can also be used.

5.
With proper rest and medication, symptoms can significantly improve within a week, while complete healing of larger anal fissures may take about two to four weeks.

Reply Date: 2023/07/28

More Info

Chronic and acute anal fissures are common conditions that can cause significant discomfort and affect a patient's quality of life. Understanding the differences between these two types of fissures, as well as their management, is crucial for effective treatment.
1. Chronic vs. Acute Anal Fissures: Based on your description, it seems that you are experiencing a recurrent issue with anal fissures. An anal fissure is classified as acute if it has been present for less than six weeks. If it persists beyond this time frame, it is considered chronic. Given that you had an initial fissure that healed but then reopened after a hard bowel movement, it is likely that you are dealing with a chronic fissure that has episodes of acute exacerbation. The pain you experience during bowel movements and the discomfort after standing are typical symptoms of anal fissures.

2. Impact of Hemorrhoids on Healing: The presence of a third-degree mixed hemorrhoid can indeed complicate the healing of an anal fissure. Hemorrhoids can cause additional irritation and pressure in the anal area, which may hinder the healing process of the fissure. When hemorrhoids protrude, they can create a cycle of pain and discomfort that may lead to further straining during bowel movements, exacerbating the fissure.

3. Topical Treatments: Regarding the use of topical treatments, both zinc oxide ointment and specific hemorrhoid creams (like those containing hydrocortisone or witch hazel) can provide relief. Zinc oxide is known for its protective barrier properties and can help soothe the skin, while hemorrhoid creams may reduce inflammation and discomfort. However, the choice between the two may depend on your specific symptoms. If the fissure is painful and inflamed, a cream designed for hemorrhoids may provide more targeted relief. It's essential to consult with your healthcare provider for personalized recommendations.

4. Application of Ointments: When applying ointments, it is crucial to maintain hygiene and avoid further irritation. If you are concerned about injuring yourself while applying the ointment, consider using a cotton swab or your finger with a gentle touch. It is important to apply the medication to the affected area without causing additional trauma. If the fissure is deep and visible, it may be beneficial to apply some ointment internally, but do so carefully to avoid any injury.

5. Healing Time for Deep Fissures: The healing time for deep anal fissures can vary significantly from person to person. Generally, acute fissures may heal within a few weeks with appropriate treatment, while chronic fissures can take longer, sometimes several weeks to months, especially if there are complicating factors such as hemorrhoids or ongoing constipation. Maintaining a high-fiber diet, staying hydrated, and possibly using stool softeners can help prevent further trauma during bowel movements, aiding in the healing process.

In conclusion, it is essential to follow up with your healthcare provider to discuss your symptoms and treatment options. They may recommend further interventions, such as dietary changes, topical treatments, or even surgical options if conservative measures fail. Regular follow-ups can help monitor the healing process and adjust treatment as necessary. Remember, managing bowel habits and addressing any underlying issues, such as hemorrhoids, will be key to preventing recurrence and promoting healing.

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