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

Written by Wang Hui Jie
Gastroenterology
Updated on September 23, 2024
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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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What is the best treatment for anal fissures?

The treatment of anal fissures depends on the specific situation. For initial onset anal fissures, since the fissure is small, treatment can be achieved through methods such as Chinese herbal fumigation or topical application of medicine. For recurrent anal fissures that have persisted for a longer time, fumigation and washing with medicine are less effective. In such cases, surgical treatment is necessary, and it should be sought at the proctology department of a formal hospital. Anal fissures are greatly related to bowel habits, so it is important to maintain smooth bowel movements by, for example, drinking more water, eating more high-fiber foods, consuming less spicy and stimulating foods, abstaining from alcohol, and avoiding greasy foods.

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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.

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Written by Xu Jun Hui
General Surgery
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How to treat hemorrhoids, bloody stool, and anal fissures?

Hemorrhoids and anal fissures are two different conditions. Generally, the early treatment for anal fissures is similar to that for early hemorrhoids, which is conservative treatment. This includes ensuring smooth bowel movements, preventing constipation, avoiding dry stools, preventing prolonged bowel movements, and avoiding sitting still for long periods. If the amount of bleeding is small, conservative treatment as mentioned above, along with the application of local medication around the anus, can control the symptoms. Regularly consume vegetables and dietary fiber. If there is severe bleeding from hemorrhoids or severe pain due to a large fissure in anal fissures, relevant examinations should be conducted. After ruling out other conditions, surgery may be necessary.

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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 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.