Is anal fissure serious?

Written by Hu Xiang Dang
Colorectal Surgery Department
Updated on September 17, 2024
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People often ask whether anal fissures are serious and what the consequences might be if they are not treated. Although treating anal fissures is not particularly difficult clinically, many patients, due to a lack of treatment knowledge and awareness of the condition, often delay treatment, which can cause some harm to their health. If an anal fissure is not treated, in addition to the pain during bowel movements and bleeding that the fissure itself causes, over time, it could also lead to conditions such as anal fistula and hypertrophied anal papillae. At the end of the fissure, a sentinel pile may develop. Due to the repeated irritation by fecal matter in an inflamed fissure, a linear ulcer may form. The skin and subcutaneous tissue around the anus might undergo fibrosis, thickening, or. form a hard lump. If the fissure repeatedly becomes infected, it can lead to the development of an anal sinus, and after infection, it may cause subcutaneous fistulas or abscesses. Of course, if an anal fissure persists over time, due to long-term spasm and fibrosis of the internal sphincter, it can lead to consequences such as anal stenosis.

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Written by Wang Ji Zhong
Internal Medicine
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Are anal fissures and hemorrhoids the same thing?

Hemorrhoids and anal fissures are common clinical conditions, but their symptoms are completely different. Generally, they both share a common symptom, which is the presence of rectal bleeding, and this bleeding is usually bright red blood. The difference between anal fissures and hemorrhoids is that anal fissures primarily cause pain, while hemorrhoids primarily cause bleeding. Hemorrhoids only cause severe pain when external hemorrhoids become inflamed and swollen, while anal fissures often involve enlargement of the anal papillae. Hemorrhoids do not involve enlargement of the anal papillae, and while anal fissures can involve skin tears around the anal canal, hemorrhoids do not. During a digital rectal exam, this can be diagnosed; hemorrhoids are caused by poor local venous circulation, leading to venous congestion and the formation of vascular bulges. Depending on their location, they are divided into internal and external hemorrhoids. Anal fissures are skin tears located on the more lateral parts of the anus, and during defecation, the tear worsens, bleeding and causing severe pain, whereas hemorrhoids usually do not cause severe pain.

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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 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 Hu Xiang Dang
Colorectal Surgery Department
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What is the best treatment for anal fissures?

How should an anal fissure be treated? It can be addressed from several aspects. First, let's talk about general treatment. What is the principle of our treatment? It is to relieve pain after bowel movements and gradually promote the healing of the fissure. However, the first step is to relieve the spasm of the sphincter, then facilitate bowel movements to interrupt the vicious cycle. But what specific measures are there? One is to take a sitz bath with traditional Chinese medicine for pain relief, such as "Shen Soup," and a 1:5000 potassium permanganate solution after defecation, maintaining local cleanliness. Then, by orally taking some laxatives or paraffin oil, feces can be softened and lubricated. Alternatively, by increasing water intake and eating more fiber-rich foods, constipation can be corrected to keep the bowels clear. In more severe cases, such as those with sphincter spasms, we can perform anal dilation under local anesthesia. By dilating the anus, the spasm of the sphincter can be relieved, and the healing of the fissure can also be promoted. However, this method has a relatively high recurrence rate, and there may also be complications such as severe bleeding, perianal abscess, and fecal incontinence. Anal dilation should be treated by a doctor, and patients should not blindly use it themselves. Of course, there is also surgical treatment. Once an anal fissure has reached a certain degree, generally a chronic anal fissure, many patients need to undergo surgical treatment. Naturally, there are several surgical methods available. We choose different surgical methods according to the condition and severity of the anal fissure. For example, if the patient has an anal fissure that presents with sentinel piles and hypertrophic anal papillae, but there is no anal stricture or internal sphincter spasm, a simple excision of the fissure can be performed. This involves removing the pathological tissue of the fissure, excising the infective anal sinus along with the hypertrophic anal papillae and sentinel piles, allowing the fissure wound to drain openly. However, if there is associated anal stricture, or there is an internal sphincter spasm, we also need to perform an internal sphincterotomy.

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Written by Chen Tian Jing
Colorectal Surgery
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What should I do if anal fissures keep recurring?

Repeated episodes of anal fissure generally result in the formation of chronic anal fissures. The fissure in chronic anal fissures mainly presents as an ulcer surface, and because the fissure is enclosed within the local sphincter muscles, drainage is poor, thus reducing the likelihood of healing. When patients with anal fissures suffer from long-term recurrent episodes, they also experience spasms of the local anal sphincter and tightening of the anal canal, which can lead to difficulties in bowel movements and dry stools in the anal region. When the spasm of the local anal sphincter worsens, the pain may cause patients to be afraid of defecating voluntarily, thereby creating a vicious cycle of recurrent episodes. The best treatment for recurrent chronic anal fissures is surgical intervention.