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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What is the best treatment for a minor anal fissure?

Minor anal fissures, which are early-stage fissures, mainly manifest as pain during defecation and minor bleeding, but the pain does not last long and is primarily associated with defecation. For minor fissures, it is generally recommended to choose conservative treatment with medications and dietary regulation to ensure smooth bowel movements. Typically, after defecation, one can choose to use an anal cleansing solution or a potassium permanganate solution for a sitz bath. After the sitz bath, apply Dragon Ball ointment or nitroglycerin ointment locally to promote the healing of the ulcerated surface. At the same time, in terms of diet, one should drink more water and consume foods rich in dietary fiber to maintain smooth bowel movements as much as possible, avoiding dry and hard stools, which also helps in the healing of minor anal fissures. Additionally, patients should pay attention to keeping the anal area dry and clean, avoid irritating the wound, and prevent infection that could exacerbate the condition.

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What should pregnant women do about constipation and anal fissures?

During pregnancy, due to some special reasons, pregnant women are prone to constipation, and severe cases may develop anal fissures, bleeding, and pain. In such cases, it is first necessary to change the diet to a light one, eat more vegetables and fruits, drink more water, and develop good bowel habits. Avoid squatting for long periods. Additionally, enemas can be used to help with bowel movements, and anti-inflammatory ointments can be applied locally to the anal fissure area for disinfection. Using warm water for sitz baths can also relieve the pain from constipation and anal fissures. Routine abdominal and anal massages can alleviate symptoms and promote bowel movements.

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What should I do about rectal bleeding from an anal fissure?

Firstly, if rectal bleeding occurs before a doctor's diagnosis, it is imperative to seek medical attention promptly to rule out other conditions. The cause of the bleeding could be from a site above the anus or other diseases related to the anus, and it might not necessarily be an anal fissure. If diagnosed with an anal fissure, treatment generally involves the local application of ointment. It is important to avoid conditions in daily life that could lead to constipation or diarrhea, as these can irritate the mucous membrane of the anus and exacerbate the symptoms of an anal fissure. Dietarily, it is beneficial to eat more vegetables, fruits, and foods high in rough fiber to ensure that stools are well-formed. If anal fissures recur, do not avoid seeking medical help, as this could lead to the formation of scars and contractions around the anus, causing anal stenosis, at which point surgery would be necessary.

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How to treat anal fissures and constipation?

Anal fissures and constipation are generally accompanying symptoms. When the stool is dry, the patient exerts excessive force during defecation, causing the stool to tear the local anal sphincter and mucosa, resulting in an anal fissure. Prolonged and recurrent anal fissures, due to the contraction of the local anal sphincter, can make defecation difficult for patients, or, because of the severe pain during defecation, patients may avoid defecating. This leads to stool remaining in the intestinal lumen for too long, causing the stool to dry out and further inducing constipation. To treat anal fissures and constipation, it is first necessary to lubricate the stool. One can take oral medications for lubricating the intestines and easing bowel movements or use topical lubricants. Treatment can also be complemented with anal dilation therapy or surgery through endoscopic incision, and applying a traditional Chinese medicine hot compress to the local fissure.

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The differences between stages one, two, and three of anal fissures.

In clinical practice, anal fissures are not categorized into stages one, two, or three; they are primarily classified as either acute or chronic anal fissures. Acute anal fissures, which occur in the early stages of the condition, are characterized by pain during defecation and minor bleeding. For such cases, the pain usually doesn’t last long, and conservative treatment with medication can be chosen. Topical applications such as dragon's pearl ointment or nitroglycerin ointment are generally used. It is also important to keep the anal region dry and clean, perhaps by using anal washes for sitz baths, while ensuring that the stool is soft to maintain smooth bowel movements. Chronic anal fissures, on the other hand, are mainly due to the development of scars on the ulcer surface. This condition involves prolonged pain and may include some narrowing of the anus. In such cases, surgical excision of the fissure may be necessary. Post-surgery treatment may include changing dressings with medications like red oil gauze strips, golden ointment, and anal washes. (Under the guidance of a doctor for medication use)