Managing Acute Anal Fissures: Tips for Pain-Free Bowel Movements

Anal fissure bowel movement issues?

Hello, doctor.
A few days ago, I experienced a problem with anal fissures due to excessive straining from constipation, and I have already seen a doctor.
The doctor diagnosed it as an acute anal fissure, which is not serious and should heal in about two days.
However, I have been experiencing frequent urges to defecate, but when I go to the bathroom, I can only pass a small amount, about the size of half a fingertip, or sometimes nothing at all.
It feels like there is a lot of stool still in my intestines.
During bowel movements, I also tend to tense my anal sphincter out of fear due to the pain.
The stool is generally soft, except for the few days before the fissure occurred when it was hard.
Pain relief medications have not been effective for me, and while sitz baths provide temporary relief, I still cannot relax my anal muscles to have a successful bowel movement.
What should I do in this situation?

Mr. Chen, 10~19 year old female. Ask Date: 2024/07/13

Dr. Ke Fangxu reply Surgery

The typical symptoms of an anal fissure include pain during bowel movements accompanied by slight bleeding, and there may be frequent urges to defecate due to irritation from the wound.
The pain often lasts for several days, sometimes exceeding a week.
Common causes include constipation or diarrhea.
The fundamental treatment involves addressing bowel movement issues, along with warm sitz baths.
Sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
Over-the-counter hemorrhoid suppositories can also be purchased for relief.
However, to effectively resolve the issue, it is essential to improve bowel habits.
If symptoms persist without improvement, it is advisable to consult a physician for further evaluation.

Reply Date: 2024/07/13

More Info

Managing acute anal fissures can be quite challenging, especially when pain and anxiety about bowel movements exacerbate the situation. Here are some strategies to help you achieve pain-free bowel movements while dealing with an acute anal fissure.

Understanding Anal Fissures
An anal fissure is a small tear in the lining of the anus, often caused by passing hard stools or straining during bowel movements. Symptoms typically include sharp pain during and after bowel movements, bleeding, and sometimes a spasm of the anal sphincter, which can make it even more difficult to pass stool.

Immediate Management Strategies
1. Dietary Adjustments: Focus on a high-fiber diet to soften your stools. Foods rich in fiber include fruits (like apples and pears), vegetables (such as broccoli and carrots), whole grains (like oats and brown rice), and legumes (beans and lentils). Fiber supplements, such as psyllium husk, can also be beneficial. Ensure you are drinking plenty of water—aim for at least 8-10 glasses a day—to help keep your stools soft.

2. Stool Softeners: Over-the-counter stool softeners, such as docusate sodium (Colace), can help make bowel movements easier and less painful. These medications work by increasing the amount of water in the stool, making it softer and easier to pass.

3. Warm Sitz Baths: Taking warm sitz baths for 10-15 minutes several times a day, especially after bowel movements, can help relax the anal sphincter and relieve pain. This can also promote blood flow to the area, aiding in healing.

4. Topical Treatments: Your doctor may recommend topical anesthetics (like lidocaine) or nitroglycerin ointment to help relieve pain and promote healing. These medications can help relax the anal sphincter and reduce spasm, making bowel movements less painful.

5. Avoid Straining: When you feel the urge to go, try to respond promptly. Avoid straining during bowel movements, as this can worsen the fissure. If you are having difficulty, consider using a stool softener or laxative to help ease the process.

6. Relaxation Techniques: Anxiety about bowel movements can lead to muscle tension, making it harder to pass stool. Techniques such as deep breathing, visualization, or even gentle abdominal massage can help relax your body and mind, making it easier to have a bowel movement.

When to Seek Further Medical Attention
If you find that these strategies are not providing relief or if your symptoms worsen, it is essential to follow up with your healthcare provider. Persistent pain, bleeding, or signs of infection (such as fever or increased swelling) should be evaluated promptly. In some cases, further interventions such as prescription medications or surgical options may be necessary.

Conclusion
Managing an acute anal fissure requires a combination of dietary changes, proper hydration, and relaxation techniques to facilitate pain-free bowel movements. By implementing these strategies, you can help reduce pain and promote healing. Remember, it’s crucial to listen to your body and seek medical advice if your condition does not improve or if you have any concerns. Your comfort and health are paramount, and with the right approach, you can navigate this challenging situation effectively.

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