What foods should be avoided with anal fissures?

Written by Deng Heng
Colorectal Surgery
Updated on January 12, 2025
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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.

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Written by Yu Xu Chao
Colorectal Surgery
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How to distinguish between anal fissures and hemorrhoids

To distinguish between anal fissures and hemorrhoids, one can first differentiate based on symptoms. Anal fissures primarily cause pain during defecation and minor bleeding, with the pain typically lasting from 20 minutes to half an hour. Patients often have hard stools or constipation. In contrast, hemorrhoids primarily lead to intermittent painless rectal bleeding. The blood is bright red and usually in greater volume, often appearing in a spraying or dripping pattern after defecation. Some patients may also experience prolapsed hemorrhoids, often accompanied by a sensation of heaviness and foreign body in the anus. Further, through a digital rectal examination, an anal fissure can be identified by a palpable ulcer or crack at the posterior or anterior midline of the anus. Hemorrhoids, being soft venous clusters, can also be differentiated through this examination.

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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 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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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.