Symptoms: Is It Hemorrhoids or Anal Fissures?

Are these symptoms related to the anal canal?

Hello, Dr.
Ke… About two to three months ago, I experienced an anal fissure, and approximately one month after that, a small growth appeared at the anal opening.
It used to hurt when I touched it, but recently it no longer causes pain when touched.
However, I still experience pain during bowel movements, after finishing a bowel movement, and when tightening my anus.
There is also a feeling of swelling and pain when sitting.
For the past month, I have not had any rectal bleeding, and my bowel movements have been normal (twice a day, morning and evening).
However, I continue to experience pain… I am unsure whether these symptoms indicate external hemorrhoids or an anal fistula… Thank you.

Tai Rui, 30~39 year old female. Ask Date: 2011/10/10

Dr. Ke Fangxu reply Surgery

After an anal fissure occurs, granulation tissue may develop at the edges of the tear, which is what you are feeling as the "small thing." This is a normal part of the healing process for an anal fissure.
If the pain has not improved, it indicates that the fissure has not healed, and you should return to the hospital for evaluation.
Additionally, it is important to check for the presence of external hemorrhoids or fistulas.
Based on your description, it does not seem to resemble the symptoms of a fistula, as fistulas typically present with skin wounds and discharge.
However, it is still advisable to consult a physician for a definitive diagnosis.

Reply Date: 2011/10/10

More Info

Based on your description, it sounds like you are experiencing symptoms that could be related to either hemorrhoids or anal fissures. Both conditions can cause pain and discomfort in the anal area, but they have distinct characteristics and causes.

Hemorrhoids are swollen veins in the lower rectum and anus that can cause discomfort, itching, and bleeding during bowel movements. They can be classified as either internal or external. Internal hemorrhoids are usually painless but can bleed, while external hemorrhoids can be painful, especially when a blood clot forms. The small lump you mentioned could potentially be an external hemorrhoid, especially if it was painful at first and has since become less sensitive.

On the other hand, anal fissures are small tears in the lining of the anus, often caused by passing hard stools. They can lead to sharp pain during and after bowel movements, and sometimes bleeding. The pain associated with fissures is typically severe and can make bowel movements very uncomfortable. Since you mentioned that you had a fissure a couple of months ago, it’s possible that the fissure has not fully healed, which could explain the ongoing pain you are experiencing.

Given that you have not experienced any bleeding recently and your bowel movements are normal, it is possible that the pain you feel is related to the healing process of the fissure or the presence of hemorrhoids. The swelling and pain when sitting could also indicate inflammation in the area, which is common in both conditions.

What to Do Next:
1. Consult a Healthcare Provider: It is important to see a healthcare professional for a proper examination. They can visually assess the area and may perform a digital rectal exam to determine the exact cause of your symptoms.

2. Symptomatic Relief: In the meantime, you can try some home remedies to alleviate your symptoms:
- Warm Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help reduce pain and swelling.

- Topical Treatments: Over-the-counter creams or ointments specifically for hemorrhoids can provide relief from pain and itching.

- Dietary Changes: Ensure you are consuming a high-fiber diet and staying hydrated to prevent constipation, which can exacerbate both hemorrhoids and fissures.

3. Avoid Straining: When having a bowel movement, try not to strain, as this can worsen both conditions. If necessary, consider using a stool softener.

4. Follow-Up: If your symptoms persist or worsen, follow up with your healthcare provider. They may recommend further treatments, such as prescription medications or, in some cases, surgical options if conservative measures do not provide relief.

In conclusion, while your symptoms could be indicative of either hemorrhoids or anal fissures, a thorough evaluation by a healthcare professional is essential for an accurate diagnosis and appropriate treatment plan. Remember, early intervention can help prevent complications and improve your quality of life.

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