What is the best treatment for anal fissures?

Written by Hu Xiang Dang
Colorectal Surgery Department
Updated on September 09, 2024
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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 Wang Ji Zhong
Internal Medicine
1min 12sec home-news-image

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 Hu Xiang Dang
Colorectal Surgery Department
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What should I do if I have an anal fissure?

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 Du Rui Xia
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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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Written by Wang Hui Jie
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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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Written by Li Xiao Jie
Internal Medicine
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Do anal fissures need treatment?

Anal fissures require treatment. If the patient has a very mild case, there is a possibility of self-healing, though this is not very likely. For initial cases, where the fissure is small, one could consider treatment methods such as Chinese herbal fumigation, topical medications, or potassium permanganate sitz baths, all of which can achieve therapeutic effects. If the patient suffers from recurrent long-term episodes, and the fissure is deep, surgical treatment may need to be considered. This condition falls under the category of proctologic diseases. Patients can visit the proctology department where a doctor will examine them and choose an appropriate surgical method. Complete recovery is possible, so there is no need to worry. To prevent this condition, it is important to maintain smooth bowel movements, ensure cleanliness in the affected area, and avoid infections.