Anal Fissures: Causes, Symptoms, and Relief Strategies

Severe anal itching?

Hello Dr.
Ke,
Two weeks ago, I experienced a sharp pain in the anal area during bowel movements, although it wasn't very severe.
After wiping, I noticed quite a bit of fresh blood.
Before seeing a doctor, I would feel intense itching and some sharp pain in the anal area right after having a bowel movement.
I then consulted a colorectal surgeon, who diagnosed me with an anal fissure.
The doctor prescribed a topical ointment called "Bai Zhi Ning" for me to apply.
Currently, the bleeding has stopped, but the intense itching from the fissure has not improved much.
I still experience itching during bowel movements, and sometimes just applying the medication causes severe itching.
Therefore, I would like to ask Dr.
Ke:
1.
How long does it typically take for an anal fissure to heal?
2.
Is my severe anal itching symptom caused by the anal fissure?
3.
What can I do to alleviate the intense anal itching and promote faster healing?
I appreciate your response.
Thank you.

Xiao Ming, 20~29 year old female. Ask Date: 2015/08/11

Dr. Ke Fangxu reply Surgery

1.
Although anal fissures are not severe, improvement is often slow.
In addition to medication, it is important to pay attention to one's lifestyle and dietary habits.
Taking warm sitz baths can also aid in wound healing.
Generally, symptom improvement takes about one to two weeks.

2.
Anal itching is not necessarily caused by anal fissures, but fissures can exacerbate the itching.

3.
For anal itching, in addition to using anti-inflammatory and antipruritic medications, the primary step is to avoid scratching to prevent skin damage.
Secondly, it is advisable to avoid consuming spicy and irritating foods.
Lastly, temporarily refraining from using body wash or soap to clean the anal area can help avoid irritating the skin around the anus.

Reply Date: 2015/08/11

More Info

Anal fissures are small tears in the lining of the anal canal, often causing pain and discomfort during bowel movements. They can be quite distressing, and understanding their causes, symptoms, and relief strategies is essential for effective management.

Causes of Anal Fissures
Anal fissures can occur due to several reasons, including:
1. Constipation: Straining during bowel movements, especially when passing hard stools, is a common cause of fissures.

2. Diarrhea: Frequent loose stools can irritate the anal area, leading to fissures.

3. Childbirth: Women may experience fissures during or after childbirth due to the stretching of the anal area.

4. Anal Intercourse: This can also lead to trauma and fissures.

5. Underlying Conditions: Certain medical conditions, such as Crohn's disease or anal cancer, can contribute to the development of fissures.

Symptoms of Anal Fissures
The symptoms you described align with typical presentations of anal fissures, which include:
- Sharp Pain: A sharp, burning pain during and after bowel movements.

- Bleeding: Bright red blood on the toilet paper or in the toilet bowl after a bowel movement.

- Itching: Intense itching around the anus, which can be exacerbated by irritation from bowel movements or topical treatments.

- Discomfort: General discomfort in the anal area, especially when sitting or during bowel movements.

Relief Strategies
1. Topical Treatments: You mentioned using a topical ointment (保痔寧軟膏), which is often effective in promoting healing and reducing discomfort. Continue using it as directed by your physician.

2. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining. Foods high in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial.

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

4. Avoid Straining: When using the bathroom, try to relax and avoid straining. If you're constipated, consider using a stool softener or laxative as recommended by your doctor.

5. Good Hygiene: Keeping the anal area clean and dry can help prevent irritation. Use gentle, unscented wipes or water to clean the area after bowel movements.

6. Medications: If itching persists, your doctor may recommend additional treatments, such as hydrocortisone cream, to reduce inflammation and itching.

Answers to Your Questions
1. How long does it take for an anal fissure to heal?
Healing time can vary, but most acute anal fissures heal within a few weeks with proper care. Chronic fissures may take longer and sometimes require additional treatments.

2. Is the severe anal itching caused by the fissure?
Yes, the severe itching can be associated with the fissure. It may also be exacerbated by irritation from bowel movements or topical treatments.
3. How to alleviate severe anal itching and promote faster healing?
To alleviate itching, continue using your topical ointment, maintain good hygiene, and consider sitz baths. Avoid irritants, such as scented soaps or wipes, and ensure your diet supports soft stools to minimize straining.

If symptoms persist or worsen, it’s essential to follow up with your healthcare provider for further evaluation and management. In some cases, additional treatments, such as prescription medications or surgical options, may be necessary for chronic fissures.

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