Anal Fissures and Hemorrhoids: Symptoms and Treatment Options

Anal fissures & hemorrhoids

Hello Doctor: I have a few questions.
There are several vertical streaks above my anus that feel rough, like scar tissue.
Are these streaks caused by anal fissures or are they anal papillae? I have a history of hemorrhoids; several years ago, I had an external hemorrhoid located at the upper left side of the anus, which would protrude and cause pain.
Typically, I would use topical ointments along with plenty of fluids and regular bowel movements, and it would shrink and disappear within three to four weeks.
It has not recurred for several years.
Recently, I have noticed an internal hemorrhoid on the right side of my anus.
It does not cause pain when it protrudes.
My doctor initially prescribed suppositories for treatment, but I have been unable to manage this internal hemorrhoid.
Unlike the previous external hemorrhoid, which would shrink and disappear shortly after it protruded, this internal hemorrhoid seems to protrude before I have a bowel movement when I feel the urge.
After a clean bowel movement, I can push it back in, but it is difficult to predict when it will protrude again.
Unlike external hemorrhoids, which can be pushed back in and remain retracted for a while, this internal hemorrhoid seems to reappear after standing for a bit or sitting for twenty minutes.
Is this a characteristic of internal hemorrhoids? Is surgical intervention the only way to resolve this issue?

Da Xiong, 40~49 year old female. Ask Date: 2014/07/21

Dr. Xu Kaixi reply Surgery

1.
The changes in the perianal skin may be due to scar formation from a wound.
2.
The symptoms you described regarding hemorrhoids may indicate thrombosed hemorrhoids, and the primary treatment method is surgical intervention.
It is recommended that you visit a surgical outpatient clinic for a more definitive diagnosis.

Reply Date: 2014/07/21

More Info

Understanding anal fissures and hemorrhoids is crucial for managing symptoms and determining appropriate treatment options. Anal fissures are small tears in the lining of the anus, often caused by passing hard stools, while hemorrhoids are swollen veins in the lower rectum and anus, which can be either internal or external.
From your description, it seems you are experiencing symptoms related to both conditions. The rough, scar-like lines you mentioned above the anus could indeed be indicative of anal fissures or the result of previous trauma, such as from hemorrhoids. The presence of external hemorrhoids that have previously caused pain and the recent development of an internal hemorrhoid that protrudes during bowel movements are common issues.

Symptoms of Anal Fissures and Hemorrhoids
1. Anal Fissures:
- Sharp pain during and after bowel movements.

- Bright red blood on the stool or toilet paper.

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

- Itching or irritation around the anus.

2. Hemorrhoids:
- Pain or discomfort, especially during bowel movements.

- Swelling or a lump near the anus.

- Bleeding during bowel movements.

- Itching or irritation in the anal region.

- Internal hemorrhoids may protrude outside the anus during bowel movements.

Treatment Options
1. Conservative Management:
- Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements.

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

- Sitz Baths: Soaking in warm water for 10-15 minutes can relieve pain and promote healing.

- Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone or witch hazel can reduce inflammation and discomfort.

2. Medications:
- Laxatives: If dietary changes are insufficient, gentle laxatives may be recommended to ease bowel movements.

- Prescription Medications: In some cases, topical nitroglycerin or calcium channel blockers can help relax the anal sphincter and promote healing of fissures.

3. Surgical Options:
- If conservative treatments fail, surgical options may be necessary. For fissures, a lateral internal sphincterotomy can be performed to relieve tension in the anal sphincter. For hemorrhoids, procedures such as rubber band ligation, sclerotherapy, or hemorrhoidectomy may be considered, depending on the severity and type of hemorrhoids.

Your Situation
Given your history of external hemorrhoids and the recent development of an internal hemorrhoid that does not respond to conservative treatment, it is essential to consult with a healthcare provider, preferably a colorectal surgeon. They can evaluate the severity of your internal hemorrhoid and discuss whether surgical intervention is appropriate for your situation.
The behavior of your internal hemorrhoid, where it protrudes during bowel movements and is difficult to manage, is indeed characteristic of internal hemorrhoids. Unlike external hemorrhoids, which can be more easily pushed back in, internal hemorrhoids may require more careful management and, in some cases, surgical treatment if they cause significant discomfort or complications.

In summary, while conservative treatments can be effective for many, persistent symptoms or complications may necessitate surgical options. Regular follow-ups with your healthcare provider will help monitor your condition and adjust treatment as needed.

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