Chronic Anal Fissures: Symptoms, Treatment, and Care

Q: Chronic Anal Fissures: Symptoms, Treatment, and Care

Hello： The causes of anal pain generally include the following five points： 1. Thrombosed hemorrhoids, 2. Infections near the anus, 3. Anal fissures, 4. Tumors, 5. Pain of unknown origin. Based on your description, it seems more like an anal fissure, as th

"Emergency"

I am 17 years old.
During the summer vacation, I experienced hard stools and strained, which resulted in a small amount of blood on the toilet paper and pain.
I initially thought it was nothing serious, but since then, every bowel movement has been painful, and sometimes hard stools cause bleeding.
I started taking warm sitz baths daily, which improved the situation, and I no longer experience bleeding.
However, it has been almost four months, and I still experience some pain during bowel movements.
Does this mean I have chronic anal fissure? Can I avoid medical treatment if I continue with the warm sitz baths? Although it is bothersome, it does not affect my daily life, and I am still a student.
Please respond, thank you.

Juzi, 10~19 year old female. Ask Date: 2004/12/19

Dr. Wang Qichao reply Surgery

Hello: The causes of anal pain generally include the following five points: 1.
Thrombosed hemorrhoids, 2.
Infections near the anus, 3.
Anal fissures, 4.
Tumors, 5.
Pain of unknown origin.
Based on your description, it seems more like an anal fissure, as the characteristics of an anal fissure include pain and bleeding, especially during bowel movements.
Anal fissures can be classified as acute or chronic.
Ninety percent of acute anal fissures heal completely with treatment, but fifty percent may progress to chronic fissures.
The distinction between acute and chronic is based on two criteria: (1) the presence of three combined features: tags, ulcers, and hyperplastic papillae, and (2) the duration: lasting more than two months.
Initial treatment can include conservative measures: topical ointments, fiber supplements, warm sitz baths, and pain relievers, which can break the vicious cycle of the fissure and promote healing.
If the condition is stubborn and does not heal, surgical intervention may be considered.
Sincerely, Dr.
Wang Qi-Chao.

Reply Date: 2004/12/19

More Info

Chronic anal fissures can be a painful and distressing condition, particularly for someone your age. Based on your description, it seems that you may indeed be experiencing a chronic anal fissure. This condition typically arises from trauma to the anal canal, often due to passing hard stools, which can cause a tear in the lining of the anus. The symptoms you’ve described—pain during bowel movements and occasional bleeding—are classic signs of an anal fissure.

Symptoms of Chronic Anal Fissures
1. Pain: The most prominent symptom is sharp pain during bowel movements, which can last for several minutes to hours afterward.

2. Bleeding: You may notice bright red blood on the toilet paper or in the toilet bowl after a bowel movement.

3. Itching or Irritation: The area around the anus may feel itchy or irritated.

4. Tightness: You might feel a tight sensation in the anal area, especially after a bowel movement.

Treatment Options
While warm sitz baths, which you’ve been doing, can provide relief by relaxing the anal sphincter and promoting blood flow to the area, they may not be sufficient for complete healing if the fissure is chronic. Here are some additional treatment options to consider:
1. Dietary Changes: Increasing your fiber intake can help soften your stools, making them easier to pass. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial.

2. Topical Treatments: Over-the-counter creams or ointments that contain hydrocortisone can help reduce inflammation and pain. In some cases, doctors may prescribe topical nitroglycerin or calcium channel blockers to help relax the anal sphincter and promote healing.

3. Medications: If you continue to experience pain, your doctor might recommend pain relief medications or stool softeners to ease bowel movements.

4. Surgery: If conservative treatments fail and the fissure persists, surgical options may be considered. This could involve a procedure to relax the anal sphincter muscle, which can help the fissure heal.

When to Seek Medical Attention
Even though you mentioned that the pain does not significantly affect your daily life, it’s important to consult a healthcare professional if:
- The pain persists or worsens.

- You experience significant bleeding.

- You notice any changes in your bowel habits.

- You have concerns about the condition.

Conclusion
While warm sitz baths and dietary changes can be beneficial, they may not be enough to resolve a chronic anal fissure completely. It’s advisable to seek medical advice to explore further treatment options. Early intervention can prevent the condition from becoming more severe and can help you avoid potential complications in the future. Remember, it’s important to prioritize your health, even as a busy student. Don’t hesitate to reach out to a healthcare provider for a thorough evaluation and personalized treatment plan.

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Not including recurrent acute anal fissures.