Anal Fissures: Causes, Symptoms, and Treatment Options

Rectal bleeding due to anal fissures?

Hello, doctor.
I am a patient with ulcerative colitis.
At the end of May this year, my colonoscopy results showed that the mucosal tissue has healed.
Additionally, I have previously experienced anal fissures due to having stools that are thicker or harder, which caused bleeding.
In the past, the amount of blood was not significant, but since June, I had an episode where the bleeding from the anal fissure was quite substantial, dripping into the toilet.
There was a lot of blood on the toilet paper as well, and I needed to rest for the bleeding to stop, which is different from before.
However, the sharp pain during bowel movements feels similar to what I experienced previously.
Upon examination, there is a small wound around the anus, but I don't understand why the amount of blood is much greater than before.
Each time I have an anal fissure, it seems to take about 5-7 days to completely heal.

Guang, 40~49 year old female. Ask Date: 2023/08/20

Dr. Zhang Shuhao reply Surgery

If there is excessive bleeding from an anal fissure, and it is accompanied by diarrhea or mucus in the stool, it is important to consider whether rectal inflammation is causing the bleeding.
In this case, a follow-up appointment for a sigmoidoscopy is necessary, along with ongoing medication management for ulcerative colitis.
If it is confirmed that the bleeding is due to the anal fissure, it is recommended to take warm sitz baths, increase fluid and dietary fiber intake, reduce the time spent on the toilet, and apply topical ointments.
If conservative treatment is ineffective, surgical intervention for anal sphincter relaxation may be considered.

Reply Date: 2023/08/20

More Info

Anal fissures are small tears in the lining of the anus, often caused by trauma during bowel movements, particularly when passing hard or large stools. Given your history of ulcerative colitis and the recent increase in bleeding associated with your anal fissures, it’s important to understand the potential causes, symptoms, and treatment options available to manage this condition effectively.

Causes of Anal Fissures
1. Hard or Large Stools: As you mentioned, passing hard or large stools can stretch the anal canal, leading to tears.

2. Chronic Diarrhea: Frequent bowel movements can irritate the anal area, making it more susceptible to fissures.

3. Inflammatory Bowel Disease (IBD): Conditions like ulcerative colitis can contribute to anal fissures due to inflammation and changes in bowel habits.

4. Straining: Excessive straining during bowel movements can increase the pressure on the anal canal, leading to fissures.

5. Poor Blood Flow: Areas with reduced blood flow may heal more slowly, making fissures more likely to recur.

Symptoms of Anal Fissures
- Pain: Sharp, severe pain during and after bowel movements is the hallmark symptom. This pain can last for several minutes to hours.

- Bleeding: Bright red blood may be seen on the toilet paper or in the toilet bowl, as you described. The amount of blood can vary, and in your case, it seems to have increased significantly.

- Itching or Irritation: The area around the anus may feel itchy or irritated.

- Visible Tear: A small tear or cut may be visible at the anal opening.

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

2. Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone can reduce inflammation and promote healing. Additionally, topical anesthetics can help alleviate pain during bowel movements.

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

4. Medications: If conservative measures fail, your doctor may prescribe medications such as topical nitroglycerin or calcium channel blockers to increase blood flow to the area and promote healing.

5. Botulinum Toxin Injection: In some cases, injecting Botox into the anal sphincter can help relax the muscles, reducing pain and allowing the fissure to heal.

6. Surgery: If fissures are chronic and do not respond to other treatments, 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.

When to Seek Medical Attention
Given the increased bleeding you’ve experienced, it’s essential to consult with your healthcare provider. While some bleeding can be normal with anal fissures, significant or persistent bleeding warrants further evaluation to rule out other potential issues, especially considering your history of ulcerative colitis. Your doctor may recommend additional tests or treatments based on your specific situation.

In summary, managing anal fissures effectively involves a combination of dietary modifications, topical treatments, and possibly medical interventions. Since your symptoms have changed, particularly with increased bleeding, it’s crucial to follow up with your healthcare provider to ensure appropriate management and to rule out any other complications.

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