Anal Fissures and Hemorrhoids: Symptoms and Treatment

Is it an anal fissure, hemorrhoids, or something else?

Hello, Doctor: Previously, during a bowel movement, my stool was very hard, but I managed to push it out (without any bleeding).
It was hard at the front and soft at the back, but I was able to pass it all.
However, it caused significant pain around the anal area, and two days later, I noticed some blood in my stool, although it was a small amount.
The blood and stool were separate when I wiped.
After a few days, I went to see a doctor, and after a digital rectal examination, I was diagnosed with a mild anal fissure and very mild internal and external hemorrhoids.
I was prescribed medication and ointment.
A week later, the same situation occurred, and the doctor then said it was hemorrhoidal bleeding, advising me to eat more fruits and vegetables and drink more water, which should help.

I should note that I have a bowel movement every day, usually once, occasionally twice.
The aforementioned issues have arisen during a period of increased work stress and anxiety.
I would like to ask the doctor if my anxiety could also affect my gastrointestinal condition? Additionally, during that one bowel movement when the stool was hard at the front and soft at the back, would that be considered constipation?
After about a month without significant issues, last week, due to family circumstances, I didn't sleep well on Saturday (almost no sleep), and I felt quite tired on Sunday.
On Monday morning, during a bowel movement, as the stool reached the anal opening, I heard a dripping sound (which I believe was blood).
Later, when I wiped, I noticed there was bleeding again, but it was also a small amount, separate from the stool.
However, I didn't feel that the stool was hard! I then went to a large hospital to see a colorectal specialist.
After examining my anal area and performing a digital rectal exam, the doctor said that my internal and external hemorrhoids were still very mild and that there was a scab from the previous anal fissure, which was likely the source of the bleeding.

I am confused about where exactly I am bleeding from! For the past two days, my routine has been normal, and my eating habits have been regular, and I have not experienced any bleeding.
I want to know, if it is an anal fissure, how long does it typically take to heal? This situation is making me anxious.
Should I consider undergoing any other tests?

Xiao Mao, 30~39 year old female. Ask Date: 2012/04/05

Dr. Ke Fangxu reply Surgery

The common symptoms of anal fissures include pain during bowel movements and slight bleeding, while hemorrhoids typically cause milder pain but more significant bleeding.
The underlying cause of these symptoms is often related to irregular bowel movements.
The treatment methods are fundamentally similar, so patients do not need to fixate on which specific issue they are experiencing.
The key is to maintain a positive mindset and uphold good lifestyle habits.
Both anal fissures and hemorrhoids are not conditions that will resolve in just a day or two; maintaining healthy habits is not something that can be achieved in just a few days.
Consistent attention to personal diet and daily routines, along with topical medications and warm sitz baths, will naturally lead to the gradual disappearance of these symptoms.

Reply Date: 2012/04/05

More Info

Understanding anal fissures and hemorrhoids is crucial for managing symptoms and determining appropriate treatment. Both conditions can cause discomfort and bleeding, but they have different underlying causes and treatment strategies.

Symptoms
Anal Fissures:
Anal fissures are small tears in the lining of the anus, often caused by passing hard stools. Symptoms typically include:
- Sharp pain during bowel movements, which may persist for some time afterward.

- Bright red blood on the toilet paper or in the stool, often separate from the stool itself.

- A visible tear or crack in the skin around the anus.

- Spasms of the anal sphincter, which can exacerbate pain.

Hemorrhoids:
Hemorrhoids are swollen veins in the lower rectum or anus. They can be classified as internal or external. Symptoms may include:
- Painless bleeding during bowel movements, often seen as bright red blood on the toilet paper or in the toilet bowl.

- Itching or irritation in the anal region.

- Pain or discomfort, especially if the hemorrhoids are external and thrombosed (clotted).

- A lump near the anus, which may be sensitive or painful.

Causes
Both conditions can be exacerbated by factors such as:
- Straining during bowel movements, often due to constipation or hard stools.

- Prolonged sitting or standing.

- Poor dietary habits, including low fiber intake.

- Stress and anxiety, which can affect bowel habits and lead to constipation.

Treatment
For Anal Fissures:
1. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining.

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

3. Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone or lidocaine can help relieve pain and inflammation.

4. Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can promote healing and relieve discomfort.

5. Medications: In some cases, a doctor may prescribe topical nitroglycerin or calcium channel blockers to relax the anal sphincter and promote healing.

6. Surgery: If conservative measures fail, surgical options may be considered to alleviate chronic fissures.

For Hemorrhoids:
1. Dietary Adjustments: Similar to fissures, increasing fiber and fluid intake can help prevent constipation and reduce hemorrhoid symptoms.

2. Topical Treatments: Creams or suppositories specifically designed for hemorrhoids can provide relief from itching and discomfort.

3. Sitz Baths: Warm baths can soothe the anal area and reduce swelling.

4. Minimally Invasive Procedures: For persistent or severe hemorrhoids, procedures such as rubber band ligation, sclerotherapy, or infrared coagulation may be recommended.

5. Surgery: In cases of severe hemorrhoids, a hemorrhoidectomy may be necessary.

Psychological Factors
Your concern about stress and anxiety impacting your gastrointestinal health is valid. Stress can lead to changes in bowel habits, including constipation, which may contribute to the development of fissures and hemorrhoids. Managing stress through relaxation techniques, exercise, or counseling may also be beneficial for your overall health.

Recovery Time
The healing time for anal fissures can vary. Many fissures heal within a few weeks with appropriate treatment. However, chronic fissures may take longer and require more intensive management. If you experience persistent symptoms or recurrent bleeding, further evaluation may be necessary to rule out other conditions.

Conclusion
It's essential to follow your healthcare provider's recommendations and maintain open communication about your symptoms. If your symptoms persist or worsen, consider seeking a second opinion or further evaluation, such as a colonoscopy, to rule out other gastrointestinal issues. Regular follow-ups can help monitor your condition and adjust treatment as needed.

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