Chronic Anal Fissures: Symptoms, Causes, and Treatment Options

Q: Chronic Anal Fissures: Symptoms, Causes, and Treatment Options

Hello, Lemon： Based on your description, the excess tissue you mentioned is likely a satellite polyp formed around a chronic anal fissure. <br>The reason for its formation is the repeated tearing and healing of the fissure, which leads to the proliferation of excess tissue in the

Chronic anal fissure

Hello Doctor, I am 18 years old.
About a year ago, I experienced anal fissures that lasted for almost a month before I went to see a doctor (initially, I didn't feel much).
The doctor prescribed me stool softeners and ointment (along with warm sitz baths).
After that, I had no issues for more than six months, until the last two months when it started to occur intermittently again, possibly lasting for about 3 to 4 days before resolving (I have been doing warm sitz baths myself).
However, after 2 to 3 weeks, it recurred.
Today, I noticed that when I exert pressure, there are two small fleshy growths appearing just above the anal opening (symmetrical on both sides, soft, resembling the shape of a tooth root, and pinker than the surrounding area).
I only noticed them when I stretched.
Could this be caused by chronic anal fissures? Or could it be a cause of the fissures? Do I need surgery? (I am quite worried.) How can anal fissures truly heal? Thank you very much for your response!

ningmeng, 10~19 year old female. Ask Date: 2007/06/27

Dr. Ke Fangxu reply Surgery

Hello, Lemon: Based on your description, the excess tissue you mentioned is likely a satellite polyp formed around a chronic anal fissure.
The reason for its formation is the repeated tearing and healing of the fissure, which leads to the proliferation of excess tissue in the surrounding area.
This can be considered a complication arising from the anal fissure rather than a cause of it.
As for the treatment of chronic anal fissures, it can be somewhat discouraging, as the effectiveness of medication is generally poor.
In addition to medication, physicians usually recommend avoiding constipation or diarrhea to prevent symptom exacerbation.
Regular warm sitz baths can help relax the anal sphincter, promote blood circulation, and maintain wound cleanliness, providing multiple benefits.
If these measures do not yield results and are accompanied by severe pain, surgical intervention may be necessary for better outcomes.

Reply Date: 2007/06/27

More Info

Chronic anal fissures are a common condition that can cause significant discomfort and distress. They are small tears in the lining of the anal canal, often resulting from trauma during bowel movements, particularly when passing hard stools. Understanding the symptoms, causes, and treatment options for chronic anal fissures is essential for effective management and relief.

Symptoms of Chronic Anal Fissures
The primary symptoms of chronic anal fissures include:
1. Pain: This is often severe and can occur during and after bowel movements. The pain may last for several hours and can be sharp or burning in nature.

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 fissure may become itchy or irritated.

4. Visible Tags or Skin Growths: As you described, the appearance of small soft lumps or tags around the anal area can occur. These are often referred to as "sentinel piles" and can develop as a result of chronic fissures.

Causes of Chronic Anal Fissures
Chronic anal fissures can be caused by several factors, including:
- Constipation: Hard, dry stools can cause trauma to the anal canal during bowel movements.

- Diarrhea: Frequent loose stools can also irritate the anal area.

- Childbirth: Women may experience fissures after childbirth due to the stretching of the anal area.

- Anal Intercourse: This can lead to trauma and fissures.

- Underlying Conditions: Conditions such as Crohn's disease or anal cancer can also contribute to the development of fissures.

Treatment Options
1. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements. Drinking plenty of water is also crucial.

2. Medications: Over-the-counter stool softeners and topical anesthetics can provide relief. Prescription medications, such as nitroglycerin ointment or calcium channel blockers, may help relax the anal sphincter and promote healing.

3. Warm Sitz Baths: Soaking in warm water several times a day can help soothe the area and promote healing.

4. Surgery: If conservative treatments fail, surgical options may be considered. Lateral internal sphincterotomy is a common procedure that involves cutting a portion of the anal sphincter to relieve tension and promote healing.

Your Concerns
Regarding the soft lumps you observed, these are likely related to the chronic fissure and may not necessarily be the cause of the fissure itself. They can develop as a result of the body’s response to the fissure, and while they are not typically harmful, they can be bothersome.

It is important to consult with a healthcare professional, preferably a gastroenterologist or a colorectal surgeon, to evaluate your condition thoroughly. They can provide a proper diagnosis and recommend an appropriate treatment plan tailored to your needs.
In summary, chronic anal fissures can be a recurring issue, but with the right management strategies, including dietary changes, medications, and possibly surgical intervention, you can achieve relief and promote healing. Don't hesitate to seek medical advice to address your concerns and improve your quality of life.

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