What should be paid attention to for anal fissures usually?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 14, 2024
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Patients with anal fissures primarily develop the condition due to a history of dry stools or straining during early bowel movements. Therefore, it is important for patients to ensure smooth bowel movements and avoid excessive dryness of stools. Diet adjustments should include consuming more bland vegetables and fruits, and avoiding spicy foods such as chili peppers, seafood, and mutton, which are irritants. Additionally, ensuring adequate daily water intake is crucial to prevent dryness in the intestinal feces. Besides dietary and bowel adjustments, patients with anal fissures should actively seek medical treatment during acute episodes to prevent the recurrence of early fissures and the formation of chronic fissures. Early-stage fissures may be treated with topical medications to alleviate symptoms, while chronic fissures may require surgical intervention. (Medication should be administered under the guidance of a doctor.)

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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 Hu Xiang Dang
Colorectal Surgery Department
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Is anal fissure serious?

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 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 Yu Xu Chao
Colorectal Surgery
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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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Written by Chen Tian Jing
Colorectal Surgery
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How many days can an anal fissure heal?

Mild anal fissures or those with shallow cracks can generally heal within about a week through local heat application or by applying hemorrhoid cream. However, there is another type of anal fissure known as chronic anal fissure. Chronic anal fissures primarily involve ulcer-like infectious changes at the local site, hence, they cannot heal on their own and can only be alleviated by lubricating the stools and applying hemorrhoid cream locally. In some cases, conservative treatment might not be significantly effective for chronic anal fissures. If surgery is performed, the recovery time is approximately 20 days. It is recommended that patients with chronic anal fissures undergo surgical treatment with endoscopic loosening.