Chronic Anal Fissures: Treatment Options and Concerns

Inquiry about anal fissure issues?

Hello, doctor.
A few months ago, I visited a clinic due to an anal fissure, and after the physician prescribed me a suppository, I recovered quite well.
However, a few weeks ago, I experienced another anal fissure, possibly due to constipation.
I purchased the same suppository from the pharmacy, which provided some improvement.
Recently, during bowel movements, I have felt a slight pain in a different area, along with a small amount of blood on the toilet paper (I haven’t bought the suppository for treatment again), which makes me worry that this situation might continue to recur.
I am currently working on improving my body and trying to address the constipation issue, which seems to have had some effect, but I still experience pain when passing stool over the wound, and I am concerned that it might be quite serious...
I have contacted the clinic I previously visited and will return for a follow-up soon, but I would like to ask you first: 1.
Does this situation indicate that I may have developed a chronic anal fissure? 2.
If so, is surgery the only option, or are there still ways to manage it with medication and lifestyle changes? Thank you very much for taking the time to respond!

10, 20~29 year old female. Ask Date: 2024/04/10

Dr. Zhang Shuhao reply Surgery

1.
Chronic anal fissures are generally defined as symptoms persisting for more than eight weeks and are difficult to relieve with conservative treatment.
2.
Improving constipation symptoms can be achieved by increasing fluid and dietary fiber intake, reducing time spent on the toilet, and taking warm sitz baths when there are wounds.
Surgical intervention should be considered if there are chronic ulcers or excessive tightness of the sphincter.

Reply Date: 2024/04/10

More Info

Chronic anal fissures can be a painful and distressing condition, often resulting from trauma to the anal canal, typically due to constipation or passing hard stools. Your experience of having a fissure that initially healed but then recurred due to constipation is not uncommon. Let's address your concerns regarding the potential chronicity of your fissure and the treatment options available.

1. Chronic Anal Fissure Diagnosis: Given that you have experienced recurrent pain and bleeding during bowel movements, it is possible that you may have developed a chronic anal fissure. Chronic fissures are typically defined as those that persist for more than eight weeks and may exhibit characteristics such as a thickened edge or the presence of a sentinel pile (a small skin tag that forms near the fissure). The presence of blood on toilet paper and pain during bowel movements are classic symptoms of fissures, and if these symptoms persist, it is advisable to seek further evaluation from a healthcare provider.

2. Treatment Options: If your fissure is indeed chronic, there are several treatment options available, and surgery is not the only solution. Here are some approaches that can be considered:
- Conservative Management: This includes dietary modifications to prevent constipation, such as increasing fiber intake through fruits, vegetables, and whole grains, as well as ensuring adequate hydration. Over-the-counter stool softeners may also be beneficial. Regular exercise can help promote bowel regularity.

- Topical Treatments: Medications such as topical nitroglycerin or calcium channel blockers (like diltiazem) can help relax the anal sphincter and promote healing of the fissure. These treatments can be effective in reducing pain and promoting healing without the need for surgery.

- Botulinum Toxin Injection: In some cases, an injection of botulinum toxin into the anal sphincter can help reduce muscle tension and promote healing. This is a minimally invasive procedure and can be effective for chronic fissures.

- Surgical Options: If conservative measures fail, surgical intervention may be necessary. The most common surgical procedure for chronic anal fissures is lateral internal sphincterotomy, which involves cutting a portion of the anal sphincter muscle to relieve tension and promote healing. This procedure has a high success rate but, like any surgery, carries risks and potential complications.

3. Lifestyle Modifications: In addition to medical treatments, lifestyle changes play a crucial role in managing anal fissures. Regular bowel habits, avoiding straining during bowel movements, and using the bathroom when the urge arises can help prevent further injury to the anal canal.
4. Follow-Up Care: It is excellent that you have already scheduled a follow-up appointment with your previous healthcare provider. They will be able to assess the severity of your fissure and recommend the most appropriate treatment based on your specific situation.

In conclusion, while the recurrence of your anal fissure is concerning, there are multiple avenues for treatment that do not necessarily involve surgery. It is essential to address the underlying issue of constipation and to consider both conservative and medical management options. Regular follow-up with your healthcare provider will be crucial in monitoring your condition and ensuring appropriate treatment. Remember, early intervention can often prevent the progression to chronicity and the need for more invasive procedures.

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