Anal Fissures: Symptoms, Treatment, and Care Tips - Gastroenterology and Hepatology

Anal fissure issues?

Previously, I experienced rectal bleeding.
In March, I was diagnosed with an anal fissure, and by July, it had recurred with bleeding.
Upon further examination, it was confirmed that the fissure had not healed.
Currently, my bowel movements require slight straining in the morning to pass.
I do not experience diarrhea easily, but if I have two or three bowel movements, bleeding may occur.
Recently, I have also felt pain when wiping the area with toilet paper, although it subsides quickly.
I have consulted with a traditional Chinese medicine practitioner who suggested using Ziyun ointment.
How should I apply it? Should I use a cotton swab or my fingers? Should I apply it to the anal opening or insert it inside?

Xue, 20~29 year old female. Ask Date: 2023/08/14

Dr. Chen Shidian reply Gastroenterology and Hepatology

I don't understand Traditional Chinese Medicine.
Western medicine allows for the application of anal ointments (which come with applicators, but can also be applied with a finger) and the use of stool softeners.

Reply Date: 2023/08/14

More Info

Anal fissures are small tears in the lining of the anal canal, often resulting in significant discomfort and bleeding during bowel movements. Understanding the symptoms, treatment options, and care tips for anal fissures is essential for effective management and recovery.

Symptoms of Anal Fissures
The primary symptoms of anal fissures include:
1. Pain during Bowel Movements: This is often described as a sharp, burning sensation that can last for several minutes to hours after passing stool.

2. Bleeding: Bright red blood may be seen on the toilet paper or in the toilet bowl after a bowel movement.

3. Itching or Irritation: The area around the fissure may feel itchy or irritated.

4. Visible Tear: In some cases, a fissure may be visible as a small tear or crack in the skin around the anus.

Treatment Options
1. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial.

2. Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone can help reduce inflammation and pain. Additionally, topical anesthetics like lidocaine may provide temporary relief.

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

4. Medications: In some cases, doctors may prescribe medications to relax the anal sphincter, which can help reduce pain and promote healing. These may include topical nitroglycerin or calcium channel blockers.

5. Surgery: If conservative treatments fail and the fissure persists, surgical options such as lateral internal sphincterotomy may be considered. This procedure involves cutting a small portion of the anal sphincter muscle to relieve tension and promote healing.

Care Tips
1. Gentle Cleaning: After bowel movements, gently clean the area with water instead of toilet paper to avoid irritation. Pat the area dry with a soft cloth.

2. Avoid Straining: Try not to strain during bowel movements. If you feel the urge to go, do not delay, as this can lead to harder stools.

3. Use of Moisturizers: Applying a barrier cream or ointment around the anal area can help protect the skin and reduce irritation.

4. Follow-Up Care: Regular follow-up with your healthcare provider is essential to monitor the healing process and adjust treatment as necessary.

Application of Traditional Remedies
Regarding the use of traditional remedies such as 紫雲膏 (Ziyun ointment), it is generally safe to apply it externally around the anal area. Here are some tips for application:
- Use Clean Hands or Cotton Swabs: It is advisable to use clean hands or a cotton swab to apply the ointment. This minimizes the risk of introducing bacteria into the area.

- External Application: Apply the ointment gently around the anal opening rather than inserting it into the anal canal. Inserting ointment can cause further irritation or discomfort.

- Frequency: Follow the instructions provided by your healthcare provider or the product label regarding how often to apply the ointment.

Conclusion
Anal fissures can be a painful and frustrating condition, but with appropriate care and treatment, they can heal effectively. It is essential to maintain a high-fiber diet, stay hydrated, and follow good hygiene practices. If symptoms persist or worsen, consulting a healthcare professional for further evaluation and management is crucial. Remember, while traditional remedies can provide relief, they should complement, not replace, conventional medical treatments.

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