Anal Fissures: Pain Management and Recovery Tips

Anal fissure pain

Hello, Dr.
Ke! Last Thursday morning, I had hard and dry stools, and due to some straining, I experienced anal pain and bleeding.
I initially thought it would heal on its own, but by Tuesday, the pain became unbearable, and I sought medical attention in the afternoon.
The doctor diagnosed me with an anal fissure and advised me to take warm sitz baths 3 to 4 times a day, and prescribed pain relief medication and "Yizhi Kang" ointment.
The pharmacist mentioned that the ointment should only be applied to the anal opening and not inserted into the rectum.
Over the past three days, I noticed that my stools are generally not hard, but the front part remains dry and hard, causing me significant pain and bleeding every morning during bowel movements.
I would like to ask: 1.
I feel pain 2 to 3 centimeters inside the anal opening; will applying the ointment only at the anal opening be effective? 2.
Is hotter water better for the sitz baths? 3.
How can I address the dryness and hardness of the front part of my stools? Does frequent gas cause hard stools? Are there any fibrous vegetables that I can eat? 4.
Should I take a stool softener or other medications? Are there any other methods to alleviate the pain during bowel movements? 5.
The doctor mentioned that I would recover within three weeks, but does the daily severe pain indicate a lack of healing? Is it possible that I won't recover? When should I return to discuss my condition with the doctor? After recovery, will I be prone to recurrence? Thank you for addressing these questions; I really appreciate it!

Tongku de mama, 40~49 year old female. Ask Date: 2015/12/11

Dr. Ke Fangxu reply Surgery

1.
The sensory nerves extend only about one centimeter inward from the anal opening; the so-called 2-3 centimeters is merely a perception.
Ointments can be applied at the anal opening, and a little can also be applied inward.
2.
The warm water should not be too hot to avoid burns or irritation to the anal area, which could worsen anal fissures; a water temperature similar to that used for bathing infants is recommended.
3.
Increasing dietary fiber and enhancing fluid intake can often improve this condition; probiotics may also be helpful at times.
If these measures are ineffective, medication may be necessary.
4.
Pain during bowel movements can be alleviated with analgesics, and warm water sitz baths after bowel movements can also be beneficial.
If conservative treatment is ineffective, surgical intervention may be considered.
5.
Anal fissures are related to lifestyle and bowel habits, so the recurrence rate is quite high.
It is advisable to avoid constipation and to frequently take warm water sitz baths to reduce the likelihood of recurrence.

Reply Date: 2015/12/11

More Info

Anal fissures are painful tears in the lining of the anal canal, often caused by passing hard stools. Your experience of pain and bleeding after a hard bowel movement is quite common, and it’s good that you sought medical attention. Here’s a comprehensive response to your questions and some additional tips for managing your condition.

1. Effectiveness of the Ointment: The ointment prescribed, such as "益痔康," is typically designed to soothe the area and promote healing. While applying it only to the anal opening may provide some relief, it might not be sufficient if the fissure extends further inside. It’s important to follow your doctor’s advice, but if the pain persists, you might want to discuss with your healthcare provider about applying the ointment slightly higher up, as long as it is safe and recommended.

2. Temperature of the Sitz Bath: For sitz baths, the water should be warm but not scalding. The ideal temperature is usually around body temperature or slightly warmer, which can help relax the anal sphincter and increase blood flow to the area, promoting healing. Hot water can cause burns or discomfort, so it’s best to find a comfortable warmth.

3. Managing Hard Stools: To prevent hard stools, it’s essential to maintain a high-fiber diet. Incorporate plenty of fruits, vegetables, and whole grains into your meals. If you find that certain vegetables are too fibrous and cause discomfort, you may want to cook them to soften their texture. Additionally, staying well-hydrated is crucial; aim for at least 8-10 glasses of water a day. If you continue to have issues with hard stools, consider using a stool softener or a fiber supplement, but consult your doctor before starting any new medication.

4. Pain Management: In addition to the ointment and sitz baths, over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain. If your doctor has prescribed a specific pain medication, make sure to follow their instructions. If the pain during bowel movements remains severe, it’s important to discuss this with your doctor, as they may need to adjust your treatment plan.

5. Recovery Timeline and Follow-Up: Healing from an anal fissure can take time, and while your doctor mentioned a three-week recovery period, individual healing varies. If you are still experiencing significant pain after a week or two, or if the bleeding continues, it’s advisable to return to your doctor for a follow-up. They may need to reassess your condition and consider other treatments, such as topical nitroglycerin or calcium channel blockers, which can help relax the anal sphincter and promote healing.

6. Risk of Recurrence: Unfortunately, anal fissures can recur, especially if the underlying causes—such as constipation or straining during bowel movements—are not addressed. Maintaining a high-fiber diet, staying hydrated, and practicing good bowel habits can significantly reduce the risk of recurrence.

In summary, managing an anal fissure involves a combination of topical treatments, dietary adjustments, and proper hygiene practices. If your symptoms do not improve or worsen, do not hesitate to seek further medical advice. Your health and comfort are paramount, and there are various strategies and treatments available to help you recover fully.

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