How to treat anal fissures and constipation?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 20, 2024
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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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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 Du Rui Xia
Obstetrics
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How to treat postpartum constipation and anal fissures?

In cases of postpartum constipation, if it becomes severe and leads to an anal fissure, it is necessary to visit the hospital's proctology department for an examination. When an anal fissure occurs, it generally requires the use of medications to invigorate blood and dissolve stasis to facilitate wound healing. You can also apply some grease around the wound to increase the lubrication of the muscles around the anus, which can alleviate some of the difficulties experienced during defecation. In daily life, it is important to drink more water, consume plenty of fresh vegetables and fruits, avoid spicy and irritating foods that can cause internal heat, and you can also use a potassium permanganate solution for sitz baths to alleviate local pain. If the condition of the anal fissure is severe, surgical treatment may be necessary.

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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 Deng Heng
Colorectal Surgery
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What foods should be avoided with anal fissures?

People with anal fissures should avoid consuming chili peppers and alcohol. Chili peppers contain a compound called capsaicin, which can strongly irritate the nerves in the gastrointestinal tract and the ulcers of anal fissures, causing severe pain in the affected area. Additionally, capsaicin can dilate the mucosal blood vessels, leading to bleeding in the anal fissures. Alcohol has a similar effect, as it can exacerbate congestion and blood stasis in the anal and rectal areas. In most cases, consuming chili peppers and alcohol can intensify the pain.

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Written by Hu Xiang Dang
Colorectal Surgery Department
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symptoms of anal fissure

What are the symptoms of an anal fissure? The most typical symptoms of an anal fissure are clinically manifested in three aspects: pain, rectal bleeding, and constipation. Firstly, constipation: Many patients with anal fissures generally first exhibit symptoms of constipation. Then, due to the dryness and bulkiness of the stool, the skin around the anus tears, forming an anal fissure. Subsequently, because of anal pain, the patient fears defecation, which over time exacerbates the hardness of the stool. As constipation worsens, it can aggravate the fissure, thereby creating a vicious cycle. The second main symptom is pain, which is not only the most significant symptom of an anal fissure but also potentially the most intensely felt by the patient. The skin around the anus is sensitive, and damage to this skin can cause significant pain. The degree and duration of the pain can also indicate the severity of the fissure. Typically, the pain from an anal fissure is cyclical. It usually occurs during defecation, followed by a few minutes of relief. Then, pain is stimulated by the contraction of the internal anal sphincter, causing sustained spasms of the sphincter, leading to severe pain. This pain can last for several minutes or even hours. During this time, the patient may feel extremely uncomfortable and find it unbearable, some only finding relief when the sphincter muscles relax after fatigue. Then, the pain reoccurs with the next bowel movement, characterized by its cyclic nature. The third main symptom is rectal bleeding. Patients may notice droplets of blood during defecation, sometimes spotting a few drops of bright red blood in the toilet bowl or seeing streaks of blood on the stool, occasionally mixed with intestinal mucus. When wiping the anus, sometimes the toilet paper shows red blood. However, the amount of bleeding is related to the size and depth of the fissure—the larger and deeper the fissure, the more bleeding occurs. Additionally, some patients may experience itching around the anus. The ulcerated surface of the fissure, along with secretions from the anal glands, irritates the skin around the anus, which can lead to perianal eczema and itching.