Chronic Anal Pain: Symptoms and Treatment Options

Anal burning pain

Hello Doctor: I do not have a history of constipation.
About eight months ago, after having anal intercourse, I experienced swelling and pain in the anal area for a few days.
I later visited a clinic, where the doctor performed a digital examination and diagnosed me with an anal fissure.
They prescribed an ointment and oral anti-inflammatory medication, along with sitz baths.
I felt some improvement, but it never fully healed, and I occasionally still experience swelling and pain.
Upon inspecting with a mirror, I noticed a peanut-sized vein protruding outside the anus, which made me suspect it might be hemorrhoids.
About a month later, I returned for a follow-up, but this time the doctor did not examine me; they just prescribed the same medication and sent me home.

After one to two months, my condition still did not improve; I continued to experience occasional warmth and swelling in the anal area, especially after sitting on a motorcycle for a while or sitting for extended periods.
It wasn't painful enough to disrupt my daily life, but it was still bothersome since I had never experienced this before (during this time, my bowel movements were normal, occurring daily, and my stools were not particularly hard).
Therefore, I sought a second opinion at another clinic.
The doctor performed a digital examination and expressed some skepticism, suggesting there wasn't much of a problem, and only prescribed oral anti-inflammatory medication.
At this point, I began to doubt whether I was overthinking the situation and wasting medical resources, but the swelling and pain were indeed real.
After another one to two months, my condition remained unchanged, so I decided to go directly to a large hospital for evaluation.
The doctor performed a digital examination and also said there didn't seem to be a significant issue, possibly just some internal hemorrhoids, and recommended that I purchase Daflon out of pocket.
I felt somewhat frustrated.
After returning home, I took the medication and applied Xylmol, and I felt a bit better, but I still hadn't fully healed.
The pain would occasionally come and go.
I finished the medication a few months ago, but I hesitated to return to the doctor, fearing that I might be overreacting.
Currently, I experience mild warmth and pain in the anal area approximately every one to two days during the daytime.
When this occurs, I apply Xylmol to the anus before going to bed that night.
Since my first visit, I have not engaged in anal intercourse, and I feel like this situation is dragging on indefinitely.
I would like to ask the doctor if this could be classified as a chronic anal fissure, how I should proceed from here, and whether I should completely avoid sexual activity, as any anal intercourse might trigger a recurrence.
Thank you.

Sv, 20~29 year old female. Ask Date: 2024/06/16

Dr. Zhang Shuhao reply Surgery

There is a peanut-sized venous protrusion outside the anus, which is likely a venous thrombosis caused by hemorrhoidal friction and bleeding.
There may also be issues with anal fissures and hemorrhoids simultaneously.
Therefore, the doctor prescribed Daflon, recommended warm sitz baths, and suggested the use of ointments and anti-inflammatory pain relievers as reasonable treatments.
Increasing fluid intake and dietary fiber, reducing time spent on the toilet, and allowing the anal area to rest without excessive straining can all contribute to improvement.
Chronic anal fissures are defined as symptoms lasting longer than eight weeks, usually accompanied by excessive tension in the sphincter muscle; however, if you have not specifically mentioned this issue during your visits, it may not be a concern.
Regarding sexual activity, if there are mild hemorrhoids or even anal fissures, adequate relaxation and lubrication are necessary.
Moderate dilation may be possible, but if there is pain or discomfort during the process, it indicates that the wound has not yet healed, and more rest is needed.

Reply Date: 2024/06/16

More Info

Chronic anal pain can be a distressing condition, and understanding its symptoms and treatment options is crucial for effective management. Based on your description, it seems you have been experiencing ongoing discomfort following an episode of anal intercourse, which led to a diagnosis of anal fissure and possibly hemorrhoids. You have also mentioned the presence of a pea-sized vein protrusion, which raises concerns about hemorrhoids.

Understanding Chronic Anal Pain
Chronic anal pain can stem from various causes, including:
1. Anal Fissures: These are small tears in the lining of the anus, often resulting from trauma during bowel movements or anal intercourse. Symptoms include sharp pain during and after bowel movements, and sometimes bleeding.

2. Hemorrhoids: Swollen veins in the rectal area can cause discomfort, itching, and pain. They can be internal or external, with external hemorrhoids being more likely to cause noticeable lumps and discomfort.

3. Muscle Spasms: The anal sphincter can go into spasms, leading to pain that may not be directly related to fissures or hemorrhoids.

4. Infections or Inflammatory Conditions: Conditions such as abscesses or inflammatory bowel disease can also lead to chronic anal pain.

Treatment Options
Given your ongoing symptoms, here are some treatment options and recommendations:
1. Medications:
- Topical Treatments: Continue using topical medications like Xylmol, which can help soothe the area. Other options include nitroglycerin ointment or calcium channel blockers, which can help relax the anal sphincter and promote healing.

- Oral Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. If you have been prescribed Daflon, it may help improve venous circulation and reduce symptoms associated with hemorrhoids.

2. Sitz Baths: Regular sitz baths can help alleviate pain and promote healing. Soaking in warm water for 10-15 minutes several times a day can provide relief.

3. Dietary Changes: Ensure you maintain a high-fiber diet to prevent constipation and straining during bowel movements. Staying hydrated is also essential. Consider fiber supplements if necessary.

4. Avoiding Irritants: Avoid using harsh soaps or wipes in the anal area, as they can exacerbate irritation. Gentle cleansing with water is recommended.

5. Physical Therapy: Pelvic floor physical therapy can help if muscle spasms are contributing to your pain. A specialized therapist can guide you through exercises to relax the pelvic floor muscles.

6. Surgical Options: If conservative measures fail and the pain persists, surgical options may be considered. This could include procedures to repair chronic fissures or remove hemorrhoids.

Sexual Activity Considerations
Regarding your concerns about resuming anal intercourse, it is advisable to wait until you are fully healed. Engaging in anal intercourse before the area has healed can lead to a recurrence of fissures or aggravation of hemorrhoids. If you wish to resume sexual activity, consider discussing this with your healthcare provider to ensure it is safe and to receive guidance on how to do so comfortably.

When to Seek Further Medical Attention
If your symptoms persist despite treatment, or if you experience new symptoms such as significant bleeding, fever, or severe pain, it is crucial to seek further medical evaluation. A gastroenterologist or a colorectal surgeon can provide specialized care and may perform additional diagnostic tests to rule out other underlying conditions.

In summary, chronic anal pain can be managed effectively with a combination of medications, lifestyle changes, and possibly surgical interventions. Open communication with your healthcare provider is essential to tailor a treatment plan that addresses your specific needs and concerns.

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