Anal Fissures: Symptoms, Causes, and Healing Time

Q: Anal Fissures: Symptoms, Causes, and Healing Time

Answer： The significant bleeding that occurs after constipation is mostly caused by hemorrhoidal bleeding. <br>Generally, anal fissure bleeding is less common, but it cannot be completely ruled out. <br>It is also quite common for both conditions to coexist. <br>The key is to imp

Anal fissure issues?

Hello, Director Ke: I have internal hemorrhoids.
Two days ago, I had difficulty passing stool, which got stuck at the anal opening.
I had to strain for 7 to 8 minutes to get it out; the stool was hard, large, and foul-smelling.
I did not see any blood at that time, but my anus was painful for 2 to 3 hours.
When I went to the bathroom again, I noticed a significant amount of blood, which was dripping.
The next day, I visited a teaching hospital to see a colorectal surgeon.
After I described my symptoms, the doctor said it was an anal fissure without performing a digital rectal examination.
Over the past two days, I have experienced occasional anal pain and diarrhea, and there is still significant bleeding, which is dripping.
Previously, my anal fissures would heal within a day, but this time it has been three days and I am still bleeding.
I would like to ask Director Ke if this is indeed an anal fissure? Why is the bleeding so significant? If it is an anal fissure, how long will it take to heal? Thank you for your explanation, Director Ke.

Da Lao Shu, 40~49 year old female. Ask Date: 2011/12/02

Dr. Ke Fangxu reply Surgery

Answer: The significant bleeding that occurs after constipation is mostly caused by hemorrhoidal bleeding.
Generally, anal fissure bleeding is less common, but it cannot be completely ruled out.
It is also quite common for both conditions to coexist.
The key is to improve bowel habits in addition to medication treatment.
If there is substantial bleeding that does not improve, one may consider undergoing rubber band ligation or surgical intervention in an outpatient setting to prevent anemia and avoid complications.
Anal fissures typically have a longer recovery time, often exceeding two weeks.
If bowel habits are not improved, there is a possibility of developing chronic anal fissures.
As for whether it is indeed an anal fissure, a definitive answer cannot be provided without a personal examination.

Reply Date: 2011/12/02

More Info

Anal fissures are small tears in the lining of the anus, often caused by passing hard or large stools. They can lead to significant discomfort, pain, and bleeding during bowel movements. Based on your description, it seems likely that you are experiencing an anal fissure, especially considering the hard stool you described and the subsequent bleeding.

Symptoms of Anal Fissures
The primary symptoms of anal fissures include:
- Pain: This is often sharp and occurs during and after bowel movements. The pain can last for several hours.

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

- Itching or irritation: This can occur around the anus.

- A visible tear: In some cases, a fissure may be visible at the anal opening.

Causes
The most common causes of anal fissures include:
- Hard stools: As you experienced, passing large or hard stools can stretch the anal lining and cause tears.

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

- Childbirth: Women may experience fissures during or after childbirth.

- Anal intercourse: This can also lead to fissures if not done carefully.

Healing Time
The healing time for anal fissures can vary. In many cases, acute fissures (those that have been present for less than six weeks) can heal within a few days to a few weeks with proper care. However, chronic fissures (those lasting longer than six weeks) may take longer to heal and might require more intensive treatment.

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

2. Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the area and promote healing.

3. Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone can reduce inflammation and pain. Prescription medications, such as nitroglycerin ointment or calcium channel blockers, may be recommended by your doctor to help relax the anal sphincter and promote healing.

4. Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage discomfort.

5. Avoid Straining: It’s crucial to avoid straining during bowel movements. If you feel constipated, consider using a stool softener.

When to Seek Further Medical Attention
If you continue to experience significant bleeding, pain, or if the fissure does not improve with home treatment within a week or two, it’s important to follow up with your healthcare provider. They may perform a physical examination or recommend further treatments, such as:
- Botulinum toxin injections: This can help relax the anal sphincter and promote healing.

- Surgery: In cases of chronic fissures that do not respond to other treatments, surgical options may be considered.

Conclusion
Given that you have been experiencing bleeding for three days and have a history of anal fissures, it is advisable to consult with a healthcare professional for a thorough evaluation. They may perform a physical examination to confirm the diagnosis and rule out other potential issues. Remember, while anal fissures can be painful and distressing, they are generally treatable, and with the right care, healing is possible.

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