Anal Fissures: Causes, Symptoms, and Treatment Options

Anal fissure issues?

Hello, doctor.
This past week (starting from June 10), I have been having bowel movements every day, but the stools have been hard, and I have to exert a lot of effort to pass them.
In the previous days, I only needed to push, and there was no pain in the anus.
However, on June 13, in the morning, I experienced significant pain in the anus while having a bowel movement, and afterward, I noticed a small amount of blood when wiping, but it was minimal, so I didn't pay much attention to it.
Yesterday, on June 14, after having a bowel movement in the evening, I wiped and found a large amount of bright red blood on the toilet paper, but the toilet bowl was not stained.
Today, June 15, it got worse.
After my bowel movement at noon, in addition to the large amount of bright blood on the toilet paper, the water in the toilet bowl was also stained red.
This isn't my first experience with anal fissures, but the previous times were not this severe.
Moreover, after the bleeding from the bowel movement, I also noticed blood when I exerted while urinating.
I am currently on my menstrual period and cannot take a sitz bath.
The hemorrhoid ointment can only be applied to the surface of the anus.
I tried using a thin cotton swab to insert into the anus, but it was very painful even just a little bit in, so I gave up.
I cannot apply medication inside the anus, and without the sitz bath to relax, I can't reach the internal area with the ointment.
Every time I have a bowel movement or urinate, there is bleeding, and my anus is both itchy and painful.
I feel like I have a fear of using the restroom now.
Doctor, what else can I do? Will the anal fissure heal on its own in a few days?

A Pi, 30~39 year old female. Ask Date: 2024/06/15

Dr. Chen Shidian reply Gastroenterology and Hepatology

Short-term use of oral laxatives (such as magnesium oxide) can be combined with topical ointments.
During bowel movements, try to control the force, and consider passing smaller amounts in multiple attempts.
Afterward, clean the area and apply medication.

Reply Date: 2024/06/15

More Info

Anal fissures are small tears in the lining of the anus, often caused by the passage of hard or large stools. They can lead to significant discomfort, pain, and even bleeding during bowel movements. Based on your description, it seems that you are experiencing a classic case of an anal fissure, exacerbated by hard stools and straining during bowel movements.

Causes of Anal Fissures
The primary cause of anal fissures is trauma to the anal canal, typically from passing hard or large stools. Other contributing factors may include:
- Chronic constipation: This leads to straining during bowel movements, increasing the risk of fissures.

- Diarrhea: Frequent loose stools can also irritate the anal area.

- Childbirth: Women may experience fissures during or after childbirth.

- Anal intercourse: This can cause trauma to the anal lining.

- Underlying health conditions: Conditions like Crohn's disease or other inflammatory bowel diseases can increase the risk of fissures.

Symptoms
The symptoms of anal fissures can vary but commonly include:
- Sharp pain during and after bowel movements.

- Bleeding: Bright red blood on toilet paper or in the toilet bowl.

- Itching or irritation around the anus.

- A visible tear or crack in the skin around the anus.

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

2. Stool Softeners: Over-the-counter stool softeners can help make bowel movements easier and less painful.

3. Topical Treatments: Applying over-the-counter creams or ointments, such as hydrocortisone or lidocaine, can help relieve pain and inflammation. However, these may only provide temporary relief.

4. Warm Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help relax the anal muscles and promote healing.

5. Avoid Straining: It's essential to avoid straining during bowel movements. If you feel the urge to go, try not to delay it.

6. Medical Treatment: If home remedies do not provide relief, a healthcare provider may prescribe medications such as topical nitroglycerin or calcium channel blockers to help relax the anal sphincter and promote healing. In some cases, botulinum toxin injections may be recommended.

7. Surgery: If conservative treatments fail, surgical options such as lateral internal sphincterotomy may be considered to relieve tension in the anal sphincter and promote healing.

When to Seek Medical Attention
Given the severity of your symptoms, including significant bleeding and pain, it is advisable to consult a healthcare professional. They can perform a thorough examination to confirm the diagnosis and rule out other potential issues, such as hemorrhoids or more serious conditions.

Conclusion
Anal fissures can be quite painful and distressing, but with appropriate treatment and lifestyle changes, they often heal within a few weeks. However, if your symptoms persist or worsen, it is crucial to seek medical attention to prevent complications and ensure proper healing. Remember, addressing the underlying causes, such as diet and bowel habits, is key to preventing future occurrences.

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