Anal Fissures: Symptoms, Causes, and When to Seek Help

Q: Anal Fissures: Symptoms, Causes, and When to Seek Help

Hello： After having a bowel movement, there is blood when wiping, and there is pain in the area behind the anus, feeling like it is裂開. <br>The possible cause is an anal fissure, and it is recommended to have a check-up with a colorectal specialist. <br>Best wishes, Dr. <br>Lin Mi

Anal fissure?

Hello Doctor: Sometimes after I have a bowel movement (which takes about 2-3 minutes), I notice a streak of blood on the toilet paper when I wipe.
I also experience a painful sensation at the back of my anus, like it’s裂開, but the bleeding is not significant.
This condition has been ongoing for a year, with periods of improvement and worsening, especially when using a squat toilet, which increases the pain.
Occasionally, I feel an itchy sensation as if I haven't wiped thoroughly after a bowel movement, and when I wipe, I do find that to be the case.
Could you please tell me what these symptoms indicate and which specialist I should see? Thank you! P.S.
I do not have any abdominal pain or diarrhea.

Chen Da Bao, 20~29 year old female. Ask Date: 2013/03/28

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello: After having a bowel movement, there is blood when wiping, and there is pain in the area behind the anus, feeling like it is裂開.
The possible cause is an anal fissure, and it is recommended to have a check-up with a colorectal specialist.
Best wishes, Dr.
Lin Ming-Hui, Taoyuan Hospital, Department of Health.

Reply Date: 2013/03/28

More Info

Anal fissures are small tears in the lining of the anal canal, and they can cause significant discomfort and bleeding during bowel movements. Based on your description, it seems you are experiencing symptoms consistent with an anal fissure, particularly the pain during and after bowel movements, the presence of blood on toilet paper, and the sensation of itching or incomplete cleaning after using the restroom.

Symptoms of Anal Fissures
1. Pain: This is often sharp and can be severe during bowel movements, leading to a fear of passing stools, which can result in constipation.

2. Bleeding: Bright red blood on the toilet paper or in the toilet bowl is common. The blood typically comes from the fissure rather than from the rectum.

3. Itching or Irritation: This can occur due to the irritation of the anal area from the fissure or from residual stool.

4. Spasms: Some individuals may experience spasms of the anal sphincter, which can exacerbate pain and discomfort.

Causes of Anal Fissures
Anal fissures can be caused by several factors, including:
- Constipation: Straining during bowel movements can lead to tears in the anal lining.

- Diarrhea: Frequent loose stools can irritate the anal area and contribute to fissures.

- Childbirth: Women may experience fissures after giving birth.

- Anal Intercourse: This can also lead to trauma in the anal region.

- Underlying Conditions: Conditions such as Crohn's disease or other inflammatory bowel diseases can predispose individuals to fissures.

When to Seek Help
It is advisable to seek medical attention if:
- The pain is severe or persistent.

- You notice significant bleeding or blood clots.

- You experience symptoms of infection, such as fever or increased swelling.

- The fissure does not improve with home treatment after a few weeks.

Recommended Specialists
You should consider consulting a gastroenterologist or a colorectal surgeon. These specialists can provide a thorough examination, confirm the diagnosis, and recommend appropriate treatment options.

Treatment Options
1. Dietary Changes: Increasing fiber intake and hydration can help soften stools and reduce straining.

2. Topical Treatments: Over-the-counter creams containing hydrocortisone or prescription medications can help reduce inflammation and pain.

3. Sitz Baths: Soaking in warm water can help soothe the area and promote healing.

4. Medications: In some cases, medications that relax the anal sphincter may be prescribed.

5. Surgery: If conservative treatments fail, surgical options such as lateral internal sphincterotomy may be considered to relieve pain and promote healing.

Conclusion
Given that your symptoms have persisted for a year, it is important to seek medical advice. Early intervention can prevent complications and improve your quality of life. Don't hesitate to discuss your symptoms openly with your healthcare provider; they are there to help you. Remember, anal fissures are a common condition, and seeking help is a positive step towards relief and recovery.

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