Painful Anal Fissures: Treatment Options for Relief

Regarding my wife's anal fissure, it is very painful to the point that she cannot sit?

Hello Dr.
Liu, my wife has been experiencing constipation issues.
She has seen a doctor before, but now she has developed an anal fissure.
It hurts so much that she experiences pain even while sleeping or sitting, to the point of tears.
Her mood has also worsened significantly.
Could you please advise on specialized treatment centers and possible treatment options? Thank you, Dr.
Liu.

Fa Lan Ke, 30~39 year old female. Ask Date: 2006/08/12

Dr. Liu Jianting reply Urology

"Of course it can be extremely painful.
Please take her to the hospital to see a colorectal surgeon for examination and treatment as soon as possible."

Reply Date: 2006/08/12

More Info

Anal fissures are small tears in the lining of the anus, often caused by passing hard stools or straining during bowel movements. They can be extremely painful and may lead to significant discomfort during daily activities, including sitting and sleeping, as you've described. The pain can be so severe that it affects mood and overall quality of life, which is not uncommon for individuals suffering from this condition.

Treatment Options for Anal Fissures
1. Dietary Changes: The first step in managing anal fissures is to address any underlying constipation. Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and make bowel movements easier. Additionally, staying well-hydrated is crucial. Drinking plenty of water can help prevent constipation.

2. Topical Treatments: Over-the-counter topical anesthetics, such as lidocaine, can provide temporary relief from pain. Additionally, topical nitroglycerin ointment or calcium channel blockers (like diltiazem) can help relax the anal sphincter, promoting healing and reducing pain. These medications increase blood flow to the area, which can aid in the healing process.

3. Sitz Baths: Taking warm sitz baths several times a day, especially after bowel movements, can help soothe the area and promote relaxation of the anal sphincter. This practice can also help keep the area clean and reduce discomfort.

4. Medications: If dietary changes and topical treatments are insufficient, a doctor may prescribe medications to help manage pain and promote healing. Laxatives or stool softeners can also be recommended to ease bowel movements.

5. Botulinum Toxin Injections: In some cases, botulinum toxin (Botox) injections may be used to temporarily paralyze the anal sphincter muscle, allowing the fissure to heal without the strain of muscle tension.

6. Surgery: If conservative treatments fail and the fissure becomes chronic, surgical options may be considered. Lateral internal sphincterotomy is a common procedure where a small portion of the anal sphincter muscle is cut to relieve tension and promote healing.

Finding Treatment
For specialized care, you may want to seek out a gastroenterologist or a colorectal surgeon. These specialists have experience in treating anal fissures and can provide tailored treatment options based on the severity of your wife's condition. Many hospitals have dedicated gastroenterology or colorectal surgery departments, so checking with local hospitals or medical centers can be a good start.

Conclusion
It’s essential to address the pain and discomfort associated with anal fissures promptly, as they can significantly impact daily life. Encourage your wife to consult with a healthcare provider who can assess her condition and recommend an appropriate treatment plan. With the right approach, most anal fissures can heal effectively, leading to relief from pain and a return to normal activities.

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