Anal Itching and Bleeding: Causes and Treatments

Anal itching and bleeding?

Hello, Director Ke: On October 17, I experienced swelling and pain in the anal area while using the restroom.
It felt like my stool was obstructed and difficult to pass, and I noticed blood in the toilet along with continuous bleeding from the anus.
I started using a topical ointment and suppositories that were previously prescribed by my colorectal surgeon.
Since the day of the bleeding, I have had persistent itching and bleeding from the anus up to today.
Currently, there is no pain when using the restroom, but sometimes there is bleeding and sometimes not.
After using the restroom, I feel a sense of fullness in the anal area while sitting on a chair.
I would like to ask Director Ke whether this is an exacerbation of hemorrhoids or an anal fissure, and how long it might take to heal? Additionally, I would like to inquire about how to alleviate the persistent itching in my anal area that prevents me from sleeping well at night.
Thank you for your guidance, Director Ke.
PS: I had surgery for mixed hemorrhoids six years ago and underwent a double contrast barium enema three years ago.

bianfu, 40~49 year old female. Ask Date: 2013/10/21

Dr. Ke Fangxu reply Surgery

Based on your description, it seems that the likelihood of a hemorrhoid flare-up is high.
If you properly use medication, improve bowel habits, and frequently take warm sitz baths, significant improvement in anal itching can generally be seen within a week.
It is crucial for many people to avoid scratching.
If the itching is severe, please wash with clean water and apply ointment.
Temporarily avoid spicy foods and refrain from using cleansers (soap or body wash) to clean the anal area to prevent damage to the anal skin.

Reply Date: 2013/10/21

More Info

Anal itching and bleeding can be distressing symptoms, and understanding their causes and treatments is essential for effective management. Based on your description, it seems you are experiencing symptoms that could be related to either hemorrhoids (commonly referred to as piles) or anal fissures. Given your history of mixed hemorrhoid surgery, it is crucial to consider both possibilities.

Causes
1. Hemorrhoids: These are swollen veins in the lower rectum or anus. They can be internal (inside the rectum) or external (under the skin around the anus). Symptoms often include pain, itching, and bleeding during bowel movements. The blood is usually bright red and may appear on the toilet paper or in the toilet bowl.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. Symptoms include sharp pain during bowel movements, bleeding, and sometimes itching. The pain can be severe and may lead to a fear of bowel movements, which can exacerbate the problem.

3. Other Causes: Conditions such as infections, skin irritations, or inflammatory bowel disease can also lead to anal itching and bleeding. Allergic reactions to soaps, wipes, or toilet paper may contribute to itching.

Treatments
1. Topical Treatments: Since you have been using a rectal ointment and suppositories, continue with these as they can help reduce inflammation and provide relief. Over-the-counter hydrocortisone creams may also help reduce itching and swelling.

2. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements, which is crucial for both hemorrhoids and fissures. Consider incorporating more fruits, vegetables, and whole grains into your diet. Staying well-hydrated is also important.

3. Sitz Baths: Taking warm sitz baths for 10-15 minutes several times a day can help soothe the area, reduce itching, and promote healing.

4. Avoiding Irritants: Be cautious with the products you use around the anal area. Avoid scented soaps, wipes, and toilet paper that may cause irritation. Opt for gentle, unscented products.

5. Medications: If over-the-counter treatments do not provide relief, consult your healthcare provider about prescription options. They may recommend stronger topical treatments or oral medications.

6. Surgical Options: If your symptoms persist despite conservative treatment, further evaluation may be necessary. In some cases, surgical intervention may be required, especially if there are complications from hemorrhoids or if fissures do not heal.

Duration of Symptoms
The duration of symptoms can vary widely depending on the underlying cause and the effectiveness of treatment. Hemorrhoids and fissures can take a few days to several weeks to heal, particularly if lifestyle changes are implemented. If you notice no improvement within a week or if symptoms worsen, it is essential to follow up with your healthcare provider for further evaluation.

Managing Itching
For persistent itching, consider the following:
- Keep the area clean: Gently clean the anal area with water after bowel movements. Avoid vigorous scrubbing.

- Moisturize: Applying a barrier cream or ointment can help protect the skin and reduce irritation.

- Avoid scratching: This can worsen the condition and lead to infection.

Conclusion
Given your history of mixed hemorrhoid surgery and the current symptoms, it is advisable to consult with a healthcare professional, preferably a colorectal specialist, for a thorough examination. They can provide a definitive diagnosis and tailor a treatment plan to your specific needs. Early intervention can significantly improve your quality of life and prevent complications.

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