Chronic Anal Fissures: Causes and Management Tips

Anal fissure issues?

Hello, doctor.
Recently, I have been experiencing anal fissures due to hard stools before bowel movements.
They usually heal in about 3 to 7 days, but after some time, I may experience anal fissures again due to hard stools.
Since this keeps recurring, would this be considered chronic anal fissures? I didn't have this issue before, and I'm not sure why it's happening.
Is there any way to improve this condition? During the first few days of having an anal fissure, I usually take warm sitz baths.
If the fissure is more severe, I apply Xylocaine ointment.
I try to maintain a diet rich in vegetables and water, and I go to the bathroom once a day.

Hei, 30~39 year old female. Ask Date: 2015/12/27

Dr. Ke Fangxu reply Surgery

Based on your description, it seems that the likelihood of an anal fissure is higher.
Common symptoms include pain during bowel movements accompanied by slight bleeding, often preceded by issues such as constipation or diarrhea.
Treatment primarily involves topical ointments and rectal suppositories, along with warm sitz baths to effectively alleviate pain.
If symptoms persist for more than three months without healing, it can be classified as chronic anal fissure.
It is advisable to address the underlying bowel movement issues; otherwise, the treatment will only provide temporary relief and will not prevent the recurrence of symptoms.

Reply Date: 2015/12/27

More Info

Chronic anal fissures are a common condition that can significantly impact a person's quality of life. They are defined as tears in the lining of the anal canal that persist for more than eight weeks. Your description of experiencing anal fissures that heal within a week but recur suggests that you may indeed be dealing with a chronic issue.

Causes of Chronic Anal Fissures
1. Hard Stools: The most common cause of anal fissures is the passage of hard or large stools. This can be exacerbated by a low-fiber diet, dehydration, or certain medications that cause constipation.

2. Straining During Bowel Movements: Straining can lead to increased pressure in the anal region, making fissures more likely.
3. Chronic Diarrhea: Frequent bowel movements can also irritate the anal area, leading to fissures.

4. Anal Trauma: This can occur from anal intercourse, the use of certain medical instruments, or even vigorous cleaning.

5. Underlying Conditions: Conditions such as inflammatory bowel disease (IBD), sexually transmitted infections, or other systemic diseases can contribute to the development of fissures.

Symptoms
The primary symptoms of anal fissures include:
- Sharp pain during bowel movements
- Bleeding, which may appear as bright red blood on the toilet paper or in the toilet bowl
- A visible tear or crack in the skin around the anus
- Spasms of the anal sphincter, which can cause further pain and discomfort

Management and Treatment
1. Dietary Changes: Increasing fiber intake is crucial. Aim for a diet rich in fruits, vegetables, whole grains, and legumes. This can help soften stools and reduce straining during bowel movements. Additionally, ensure you are drinking plenty of water throughout the day.

2. Sitz Baths: As you mentioned, warm sitz baths can help soothe the area and promote healing. Soaking for 10-15 minutes several times a day, especially after bowel movements, can be beneficial.

3. Topical Treatments: Over-the-counter topical anesthetics like xylocaine (lidocaine) can provide temporary relief from pain. Additionally, topical nitrates or calcium channel blockers can help relax the anal sphincter and promote healing. However, these should be used under the guidance of a healthcare provider.

4. Stool Softeners: If dietary changes are insufficient, consider using stool softeners or mild laxatives to prevent hard stools.

5. Avoid Straining: When you feel the urge to have a bowel movement, try to go as soon as possible. Avoid sitting on the toilet for extended periods, as this can increase pressure on the anal area.

6. Medical Intervention: If conservative measures fail, it may be necessary to consult a healthcare provider. In some cases, surgical options such as lateral internal sphincterotomy may be recommended to relieve chronic anal fissures.

When to Seek Help
If your symptoms persist despite home management, or if you experience severe pain, significant bleeding, or signs of infection (such as fever or pus), it is essential to seek medical attention. A healthcare provider can perform a thorough examination and may recommend further diagnostic tests to rule out underlying conditions.

Conclusion
Chronic anal fissures can be a frustrating and painful condition, but with appropriate dietary changes, proper hygiene, and medical management, most individuals can find relief. It’s essential to address the underlying causes, such as hard stools and straining, to prevent recurrence. If you continue to experience issues, don’t hesitate to reach out to a healthcare professional for further evaluation and treatment options.

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