What should I do if I have an anal fissure?

Written by Hu Xiang Dang
Colorectal Surgery Department
Updated on September 23, 2024
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So, what should we do if we have an anal fissure? Generally, for patients with early-stage anal fissures where the fissure is still fresh and without complications such as sentinel piles, hypertrophied anal papillae, anal papillitis, anal stenosis, subcutaneous fistulae, or subcutaneous abscesses, conservative treatment under medical supervision can be pursued. First, altering the diet by increasing water intake and consuming more vegetables and fruits can improve the characteristics of the stool. Post bowel movement, traditional Chinese herbal remedies for pain relief, such as Shen Tang, or sitz baths using potassium permanganate solution can be used. Locally, applications like Longzhu Ointment or Jiuhua Ointment may be applied. If constipation is present, stool softeners should be used to aid bowel movements. In the chronic stage, if symptoms are only accompanied by internal sphincter spasm and no other complications such as sentinel piles or hypertrophied anal papillae, in addition to the general treatments mentioned above, anal dilation can be considered. If dilation is ineffective, then surgical treatment should be considered at this time. For patients with chronic anal fissures who also have symptoms like sentinel piles, hypertrophied anal papillae, anal stenosis, or for those who have had prolonged ineffective treatment of initial anal fissures, it is advisable to seek surgical treatment at a hospital.

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Written by Chen Tian Jing
Colorectal Surgery
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What causes anal fissures?

Anal fissure is a series of clinical symptoms such as pain or rectal bleeding that occur due to the formation of a crack in the local sphincter muscle of the anus. The main reason for the occurrence of anal fissures is due to poor defecation habits in the early stages of the patient, or excessively dry stools, and excessive force during defecation, causing the local sphincter to burst, resulting in the fissure opening pain or bleeding. To treat anal fissures, it is first necessary to soften the patient's stools and adjust defecation habits. If the patient's diet is poor, it is recommended to maintain a light, easily digestible diet long-term. For those with dry stools, appropriate oral medications to lubricate the intestines and facilitate bowel movements can be used, or sesame oil can be applied around the anus before each defecation to lubricate the stool. If recurrent episodes of anal fissures occur, surgical treatment can also be directly performed. (Medication use should be under the guidance of a doctor.)

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Written by Wang Ji Zhong
Internal Medicine
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Anal fissures occur in which part?

Anal fissures are an extremely common condition in proctology. They occur in the fragile and narrowest tissue of the anal canal due to the combined effect of various internal and external factors, leading to the opening and cracking of the digestive tract outlet up to the dentate line and the surface of the anal margin. The oval-shaped small ulcers that form from anal fissures usually occur at the anal region, aligning parallel to the longitudinal direction of the anal canal. The condition is often recurrent and difficult to heal. The angle continuation between the anal canal and the rectum means that the posterior wall of the anal canal is under the most pressure during bowel movements. Therefore, the posterior midline is most susceptible to injury and is also the most common site for the occurrence of anal fissures.

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Written by Chen Tian Jing
Colorectal Surgery
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Anal fissure bleeding symptoms

The most common clinical symptoms of anal fissure, apart from the intense tearing pain in the anal area, include bleeding during bowel movements. The bleeding from anal fissures is typically bright red, and the amount of blood can increase with the severity of the condition due to repeated stretching of the fissure. Particularly during acute episodes of anal fissures or after defecation, bleeding from the local fissure can be more significant. Patients with bleeding anal fissures generally have a history of dry stools, so the first step in treating anal fissure bleeding is to lubricate the stool. Additionally, topical medications should be applied to the bleeding fissure to promote healing, and hemorrhoid creams with hemostatic properties can be used locally to help stop the bleeding. (Please use medications under the guidance of a professional physician, and do not self-medicate.)

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Written by Li Xiao Jie
Internal Medicine
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What should not be eaten with anal fissure?

Patients with anal fissures should be cautious with their diet, avoiding spicy and irritating foods to prevent exacerbation. They should also consume foods rich in roughage, such as cornmeal, sweet potatoes, celery, leeks, and cabbage, which can facilitate bowel movements and prevent the aggravation of anal fissures due to dry stools. Additionally, alcohol should be avoided as it may dilate blood vessels and lead to increased bleeding. It is essential for patients with anal fissures to maintain smooth bowel movements and avoid sitting or squatting for extended periods.

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Written by Zhang Shu Kun
Traditional Chinese Medicine
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What should I do if I have bleeding and anal fissures due to excessive internal heat?

If anal fissures with bleeding occur after excessive internal heat, the acute phase can be treated with warm saltwater sitz baths. If the condition is severe, it is still best to visit a local reputable hospital and receive treatment based on a doctor's diagnosis. Regular attention must be paid to the diet, avoiding spicy, irritating, raw, and cold foods, as well as overly greasy or fried foods, to prevent aggravation of the condition. It is advisable to drink more warm water and eat more fresh fruits and vegetables. Paying attention to rest is crucial, especially avoiding staying up late. Regular physical exercise can also help boost the body's resistance.