Anal Fissures and Hemorrhoids: Symptoms and Treatments

Anal fissures and hemorrhoids issues?

Hello, Director Ke.

1.
If after using the restroom, I feel a protrusion from the anus that is painful, could this be hemorrhoids or rectal prolapse? Last week, I went to the hospital for an examination, and after a digital rectal exam, the doctor said I have an anal fissure.
When I asked the doctor if I have hemorrhoids, he did not clearly state whether I do or not; he only mentioned that most people have some degree of hemorrhoids, but it depends on whether they are symptomatic.
Is this true? Based on the description of my symptoms, do I have hemorrhoids? The doctor prescribed me a tube of topical ointment for hemorrhoids.
I would like to know, aside from the external area around the anus, can an anal fissure occur inside the anal canal? If the fissure is inside, will applying the ointment externally be effective? I feel uncomfortable about inserting my finger into the anus to apply the medication; what should I do? I have tried many times but am hesitant to insert my finger deeply.
After the doctor performed a digital rectal exam, it was very painful, and now I have developed a psychological barrier.
What should I do?
2.
I have had an anal fissure for ten years now.
Initially, after using the restroom, I would feel pain and itching around the anus.
Recently, I have noticed a protrusion that retracts within a day or two.
I have experienced bleeding only once, which was more significant; otherwise, it has been very minimal when I wipe with toilet paper.
Is this considered serious?

Luo Ren, 30~39 year old female. Ask Date: 2016/02/23

Dr. Ke Fangxu reply Surgery

1.
The likelihood of hemorrhoids is indeed higher; everyone has hemorrhoids, but it depends on whether there are symptoms that require treatment.
The "Hiyu Hemorrhoid Ointment" is likely intended for internal use, and if you're hesitant, you can use your finger to insert a small amount of ointment.
Alternatively, you can also use rectal suppositories.
2.
The typical symptoms of an anal fissure include pain during bowel movements accompanied by slight bleeding.
The primary cause of anal fissures is usually hard stools, but diarrhea, frequent bowel movements, or prolonged straining can also lead to fissures.
It is recommended to improve bowel habits and take warm sitz baths to alleviate symptoms.
Topical ointments and suppositories can also be used for treatment.
If symptoms persist for more than a week without improvement, it is advisable to consult a physician to identify the underlying issue.

Reply Date: 2016/02/23

More Info

Understanding anal fissures and hemorrhoids is crucial for anyone experiencing discomfort in the anal region. Both conditions can cause significant pain and distress, and while they share some symptoms, they are distinct entities with different underlying causes and treatment approaches.

Symptoms
1. Anal Fissures: An anal fissure is a small tear in the lining of the anus. Symptoms typically include:
- Sharp pain during and after bowel movements, often described as "stabbing" or "burning."
- Bright red blood on the toilet paper or in the stool.

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

- Itching or irritation in the anal area.

2. Hemorrhoids: Hemorrhoids are swollen veins in the lower rectum or anus. Symptoms may include:
- Painless bleeding during bowel movements, often noticed as bright red blood on the toilet paper or in the toilet bowl.

- A lump or swelling near the anus, which may be sensitive or painful (this is often a thrombosed hemorrhoid).

- Itching or irritation in the anal region.

- Discomfort or pain, especially when sitting.

Differentiating Between Conditions
From your description, the protrusion you feel after bowel movements could be indicative of either hemorrhoids or a complication related to your anal fissure. The fact that your doctor did not explicitly confirm the presence of hemorrhoids suggests that they may not be prominent or symptomatic at this time. It is common for many individuals to have hemorrhoids without experiencing significant symptoms.

Treatment Options
1. For Anal Fissures:
- Topical Treatments: Your doctor has prescribed a topical ointment (like the one you mentioned, "喜癒痔軟膏") which can help soothe the area and promote healing. While this is applied externally, it can still provide relief for fissures located at the anal opening.

- Sitz Baths: Soaking in warm water can help relax the anal muscles and promote healing.

- Dietary Changes: Increasing fiber intake and hydration can help soften stools, reducing strain during bowel movements.

- Pain Relief: Over-the-counter pain relievers may help manage discomfort.

2. For Hemorrhoids:
- Lifestyle Modifications: Similar to fissures, increasing fiber intake and staying hydrated can alleviate symptoms.

- Topical Treatments: Creams and ointments specifically for hemorrhoids can reduce swelling and discomfort.

- Surgical Options: In severe cases, procedures such as rubber band ligation or hemorrhoidectomy may be necessary.

Addressing Your Concerns
Regarding your discomfort with applying medication internally, it is understandable to feel apprehensive, especially after a painful examination. Here are some suggestions:
- Gentle Application: If you are uncomfortable applying medication internally, focus on the external application and consider using a cotton swab to help apply the ointment more gently.

- Relaxation Techniques: Before attempting to apply the medication, practice deep breathing or relaxation techniques to ease tension.

- Consult Your Doctor: If the pain persists or if you have significant anxiety about examinations or treatments, discuss this with your healthcare provider. They may offer alternative treatments or refer you to a specialist, such as a gastroenterologist or a colorectal surgeon.

Conclusion
In summary, while both anal fissures and hemorrhoids can cause similar symptoms, they are distinct conditions that require different management strategies. Your symptoms suggest that you may be dealing with an anal fissure, and while hemorrhoids are common, they may not be the primary concern at this time. It is essential to follow your doctor's recommendations, maintain a high-fiber diet, and manage your symptoms effectively. If you have ongoing concerns or if your symptoms worsen, do not hesitate to seek further medical advice.

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