Persistent Pain from Anal Fissure: When to Seek Medical Attention?

I have had an anal fissure for 5 days, but there has been no improvement?

Hello Doctor, five days ago I experienced a slight tear in my anus due to harder stools.
I bought some ointment to apply and have been doing warm sitz baths.
Based on my previous experiences with anal fissures, I usually feel less pain after about 3 to 4 days, unless the stools are hard.
However, it has now been five days, and my stools are not hard, but every time I apply Vaseline before a bowel movement, I feel a tearing pain in my anus again.
I would like to ask if my condition requires a visit to the hospital for examination.
Additionally, if I repeatedly contract my anus because I feel incomplete after a bowel movement, will this affect the healing of the wound? Thank you.

konfyuuz, 20~29 year old female. Ask Date: 2024/03/20

Dr. Zhang Shuhao reply Surgery

It is recommended to visit a colorectal clinic for examination.
When anal fissure wounds do not heal easily, it may be associated with excessive sphincter tension or local ulcers, which may require surgical treatment.
During the waiting period for medical attention, it is important to increase fluid and dietary fiber intake to prevent constipation, and to take warm sitz baths.
Avoid prolonged toilet sitting, as straining on the toilet can exacerbate symptoms of hemorrhoids and anal fissures, and should be minimized.

Reply Date: 2024/03/20

More Info

Persistent pain from an anal fissure can be quite distressing and may require medical attention if it does not improve with conservative measures. Based on your description, it seems that you have been experiencing pain for five days following a hard bowel movement that caused a fissure. You mentioned using a topical ointment and warm sitz baths, which are common home remedies for managing anal fissures. However, since you are still experiencing significant pain, it may be time to consider further evaluation.

When to Seek Medical Attention
1. Duration of Symptoms: If the pain persists beyond a few days, especially if it is worsening or not improving with home treatment, it is advisable to seek medical attention. Anal fissures typically heal within a few weeks, but if they do not, it may indicate a more serious issue or the development of a chronic fissure.

2. Severity of Pain: If the pain is severe and interferes with your daily activities, it is a sign that you should consult a healthcare provider. Pain that feels like tearing or is associated with bleeding during bowel movements can indicate that the fissure is not healing properly.

3. Signs of Infection: If you notice any signs of infection, such as increased redness, swelling, or discharge from the fissure, you should seek medical attention immediately.

4. Difficulty with Bowel Movements: If you are experiencing significant discomfort or fear of pain during bowel movements, leading to constipation or avoidance of bowel movements, this can create a cycle that exacerbates the fissure. It is important to address this issue with a healthcare provider.

Impact of Repeated Anal Contraction
Regarding your concern about repeatedly contracting the anal muscles due to the feeling of incomplete evacuation, this can indeed affect the healing process of an anal fissure. Frequent contractions can increase pressure in the anal area, potentially leading to further irritation and delaying healing. It is crucial to maintain a relaxed state during bowel movements to facilitate healing.

Recommendations
1. Dietary Changes: Ensure you are consuming a high-fiber diet to soften your stool and prevent further straining during bowel movements. Staying well-hydrated is also essential.

2. Topical Treatments: While you are currently using Vaseline, consider discussing with your healthcare provider the use of topical medications that contain nitroglycerin or calcium channel blockers, which can help relax the anal sphincter and promote healing.

3. Sitz Baths: Continue with warm sitz baths, as they can help soothe the area and promote blood flow, aiding in healing.

4. Medical Evaluation: If your symptoms do not improve or worsen, it is advisable to see a healthcare provider. They may perform a physical examination to assess the fissure and determine if further treatment, such as prescription medications or surgical options, is necessary.

In summary, while home remedies can be effective for managing anal fissures, persistent pain after five days suggests that you should seek medical attention. A healthcare provider can offer a thorough evaluation and appropriate treatment options to help alleviate your symptoms and promote healing.

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