Anal Fissures: Symptoms, Treatment, and Recovery Time

Anal fissure

Hello, I have been experiencing pain during bowel movements since early November, and my anus hurts, but there is no blood in the stool, only a little bit of blood when wiping (just a tiny bit).
I have seen several doctors, and one doctor prescribed stool softeners.
A couple of days ago, a different doctor diagnosed me with an anal fissure and provided me with suppositories and anti-inflammatory medication.
It has improved a bit during bowel movements, but there is still some slight pain.
How long does it usually take for an anal fissure to heal? Is surgery always necessary? Thank you.

Niming, 10~19 year old female. Ask Date: 2006/12/20

Dr. Cai Yaozhou reply Gastroenterology and Hepatology

Anal fissures are caused by hard stools tearing the anal mucosa.
They are the most common cause of rectal bleeding in children under one year of age.
During the acute phase, a tear in the mucosa can be observed at the anterior or posterior anal region, appearing bright red (Figure 1).
If the mucosal tearing recurs, it progresses to a chronic fissure, where a white fibrotic tear can be seen, often accompanied by hypertrophic mucosal polyps.
Treatment for acute fissures typically involves oral stool softeners and regular cleaning of the anal area, which can lead to healing.
Chronic anal fissures usually require surgical intervention.

Reply Date: 2006/12/20

More Info

Anal fissures are small tears in the lining of the anus, often caused by passing hard stools, constipation, or prolonged diarrhea. They can lead to significant discomfort and pain during bowel movements, as well as minor bleeding, which is typically noticed on toilet paper or in the toilet bowl. Your symptoms, including pain during bowel movements and slight bleeding, align with common presentations of anal fissures.

Symptoms of Anal Fissures
The primary symptoms of anal fissures include:
1. Sharp Pain: This is often described as a "stabbing" pain during and after bowel movements.

2. Bleeding: Usually minimal, it may appear as bright red blood on toilet paper or in the toilet.

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

4. Spasms: Some individuals experience muscle spasms in the anal sphincter, which can exacerbate pain.

Treatment Options
The treatment for anal fissures typically begins with conservative measures, which may include:
1. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements.

2. Hydration: Drinking plenty of water is essential to prevent constipation.

3. Stool Softeners: Medications like docusate sodium can help make bowel movements easier.

4. Topical Treatments: Creams or ointments containing nitroglycerin or calcium channel blockers can help relax the anal sphincter and promote healing.

5. Warm Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help relieve pain and promote healing.

Recovery Time
The healing time for anal fissures can vary. Many fissures heal within a few weeks with appropriate conservative treatment. However, if the fissure persists for more than six weeks, it may be classified as a chronic fissure, which may require more aggressive treatment.

Surgical Options
Surgery is generally considered a last resort for chronic fissures that do not respond to conservative treatments. The most common surgical procedure is lateral internal sphincterotomy, which involves cutting a small portion of the anal sphincter muscle to relieve tension and promote healing. This procedure has a high success rate but carries risks, including potential incontinence.

When to Seek Further Medical Attention
If your symptoms do not improve with conservative treatment, or if you experience increased pain, significant bleeding, or signs of infection (such as fever or pus), it is important to follow up with your healthcare provider. They may recommend further evaluation or consider surgical options if necessary.

In summary, while anal fissures can be quite painful and uncomfortable, many cases resolve with conservative management. It is essential to maintain a high-fiber diet, stay hydrated, and follow your doctor's recommendations for topical treatments. If your symptoms persist or worsen, further evaluation may be warranted to explore additional treatment options.

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