Is It Anal Fissure or Just a Banding Injury? Your Symptoms

Is this an anal fissure?

Hello, Dr.
Ko.
I have both internal and external hemorrhoids.
I experienced pain during bowel movements and itching around the anus, so I consulted a doctor.
After examination, the doctor diagnosed me with internal hemorrhoids and performed rubber band ligation.
However, after the procedure, I have been experiencing severe pain during bowel movements, feeling like I'm being cut with a knife, and the pain lasts for several minutes before subsiding.
Today (August 3rd, the ligation was done three days ago), I looked in the mirror and noticed a linear wound next to the external hemorrhoid at the anal opening.

1.
Is this the ligation wound, or could it be an anal fissure?
2.
If it is an anal fissure, what should I do? Do I need to return for another ligation? I'm worried that using an anoscope will further open the wound.
I'm really distressed about this.

Nìmíng, 30~39 year old female. Ask Date: 2015/08/05

Dr. Ke Fangxu reply Surgery

1.
If the hemorrhoid ligation is performed too superficially, it may result in pain; the linear wound you observe is likely due to the ligation.
2.
It is recommended to start with warm sitz baths and apply hemorrhoid ointment.
Generally, healing occurs within one to two weeks.
If the wound does not heal over time and the pain persists, it is advisable to consult a physician for evaluation.

Reply Date: 2015/08/05

More Info

It sounds like you're experiencing significant discomfort following a rubber band ligation for your internal hemorrhoids, and you're understandably concerned about the possibility of an anal fissure. Let’s break down your symptoms and address your questions.

1. Is the linear wound next to the external hemorrhoid a result of the ligation or an anal fissure?
The linear wound you observed could potentially be a result of the rubber band ligation procedure. This procedure can sometimes cause irritation or minor trauma to the surrounding tissue, leading to superficial wounds. However, if the pain is severe and resembles a sharp, cutting sensation, it could also indicate an anal fissure. An anal fissure is a small tear in the lining of the anus, often caused by passing hard stools or straining during bowel movements.
2. If it is an anal fissure, what should you do?
If you suspect that you have developed an anal fissure, there are several steps you can take to alleviate the pain and promote healing:
- Dietary Changes: Increase your fiber intake to soften your stools. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial.

- Sitz Baths: Taking warm sitz baths for 10-15 minutes several times a day can help soothe the area and promote blood flow, which aids in healing.

- Topical Treatments: Over-the-counter topical anesthetics or hydrocortisone creams can provide temporary relief from pain and inflammation.

- Avoid Straining: Try to avoid straining during bowel movements, as this can exacerbate the pain and delay healing.

3. Should you return for a follow-up appointment?
It’s advisable to follow up with your healthcare provider, especially if the pain persists or worsens. They can perform a thorough examination to determine whether the wound is a result of the ligation or an anal fissure. If it is indeed a fissure, they may recommend additional treatments, such as prescription medications or, in some cases, surgical options if conservative measures fail.

4. Concerns about using an anoscope:
Your concern about the use of an anoscope is valid, especially if there is a painful wound present. It’s important to communicate your discomfort to your doctor. They may be able to perform a gentle examination or suggest alternative methods to assess the area without causing further pain.

In conclusion, while the linear wound could be a result of the ligation, the sharp pain you are experiencing raises the possibility of an anal fissure. Implementing dietary changes, using sitz baths, and applying topical treatments can help manage your symptoms. However, a follow-up appointment is essential to ensure proper healing and to address any complications. Your health and comfort are paramount, so don’t hesitate to seek further medical advice.

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