What causes anal fissures?

Written by Chen Tian Jing
Colorectal Surgery
Updated on October 29, 2024
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Anal fissure is a series of clinical symptoms such as pain or rectal bleeding that occur due to the formation of a crack in the local sphincter muscle of the anus. The main reason for the occurrence of anal fissures is due to poor defecation habits in the early stages of the patient, or excessively dry stools, and excessive force during defecation, causing the local sphincter to burst, resulting in the fissure opening pain or bleeding. To treat anal fissures, it is first necessary to soften the patient's stools and adjust defecation habits. If the patient's diet is poor, it is recommended to maintain a light, easily digestible diet long-term. For those with dry stools, appropriate oral medications to lubricate the intestines and facilitate bowel movements can be used, or sesame oil can be applied around the anus before each defecation to lubricate the stool. If recurrent episodes of anal fissures occur, surgical treatment can also be directly performed. (Medication use should be under the guidance of a doctor.)

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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 Hu Xiang Dang
Colorectal Surgery Department
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What medicine is used for anal fissures?

So, what medications can patients with anal fissures use routinely? If an anal fissure occurs, during the early stages when the fissure is new, we can use ointments such as Dragon Pearl Ointment, Jiu Hua Ointment, Musk Hemorrhoids Ointment, and Ganthai Ointment, which are hemorrhoid ointments that remove decay and promote tissue regeneration, to facilitate the healing of the wound. After defecating, we can use traditional Chinese medicine pain relievers like Shen Soup or a potassium permanganate solution for cleansing. After cleaning, we should also use some hemorrhoid suppositories for insertion into the anus, which can be used 1-2 times daily. Additionally, oral medications should be taken to lubricate the intestines and aid bowel movements. For example, liquid paraffin, hemp seed pills, hemp seed capsules, and polyethylene glycol electrolyte powder (solution), etc., to soften the stool and improve bowel conditions. If there is severe pain during or after bowel movements due to the anal fissure, local anesthesia like ropivacaine can be used at the Changqiang acupoint for a prolonged pain relief, and long-lasting pain relievers can also be injected at the base of the fissure to relieve pain during defecation. Considering the individual differences of patients, the specific medications, dosages, and precautions should be followed. It is crucial for patients to consult a doctor before using any medications to prevent misuse of drugs.

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How to examine anal fissures in women

If a woman suspects symptoms of an anal fissure, it is recommended to directly perform a digital rectal examination rather than an anoscopy, to avoid worsening the condition by potentially tearing local fissures with the anoscope. Typically, an anal fissure presents with severe local pain in the anus, bleeding during bowel movements, and accompanying hard stools. Therefore, the initial treatment should focus on softening the stool, for which one can take oral hemp seed oil capsules to facilitate bowel movements. Additionally, applying Recovery New liquid as a hot compress on the local fissures can help alleviate symptoms and promote healing. If there is anal constriction, anal dilation therapy might be chosen, or treatment may involve a lateral internal sphincterotomy. (Please use the above medications under the guidance of a physician, and do not use them indiscriminately on your own.)

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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.

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Written by Hu Xiang Dang
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What should be paid attention to usually for anal fissures?

What should I pay attention to for anal fissures? Friends who suffer from anal fissures should note the following: Firstly, pay attention to your diet. Adjust your diet structurally to be diverse. Drink plenty of water and eat less spicy and stimulating food; abstain from alcohol and betel nuts; eat less spicy hot pot and similar foods. Also, maintain a smooth bowel movement. We should develop a habit of defecating regularly, and treat constipation correctly. However, in treating constipation, we should not misuse laxatives and should use medications under the proper guidance of a doctor. We should also pay attention to keeping the anal area clean and hygienic by washing it after each bowel movement. After defecation, it is best to perform sitz baths using salt water, traditional Chinese medicine pain relievers like Shen Tang, or potassium permanganate solution. This helps in the recovery of the anal fissure. In addition to the above, we should also engage in appropriate activities. Friends with anal fissures can perform anal muscle contractions, such as Kegel exercises or stretching exercises.