Is anal fissure serious?

Written by Hu Xiang Dang
Colorectal Surgery Department
Updated on September 17, 2024
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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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What should I do if I have anal fissure bleeding?

The main symptoms of patients with anal fissures are bleeding and pain. Extended periods of bleeding can first lead to local infections and secondly to systemic anemia, thus immediate and timely treatment is necessary. Firstly, maintaining good personal hygiene is crucial; this includes daily cleaning of the anal area and using hot sitz baths to help improve venous circulation. Secondly, it's important to drink plenty of water, eat fresh vegetables and fruits, avoid spicy foods, and ensure regular bowel movements. In this situation, topical medications can be used. Treatment with suppositories that invigorate the blood and reduce stagnation can have a local anti-inflammatory effect. If medication does not sufficiently resolve the issue, surgical treatment options such as internal anal sphincterotomy or anal fissurectomy can be considered, which can provide a complete cure.

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Written by Chen Tian Jing
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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.

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Written by Yu Xu Chao
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Can you have intercourse during an anal fissure?

During an anal fissure, it is possible to have sexual intercourse without any impact on the fissure itself. For patients with an anal fissure, the main focus should be on maintaining smooth bowel movements and avoiding dry and hard stools to prevent irritating the wound, which can cause pain and bleeding. It is also important to avoid diarrhea, as frequent bowel movements can irritate the wound over time and worsen the fissure. Clinically, for early-stage anal fissures, conservative treatment with medications is often recommended, along with softening the stool. Commonly used medications include Dragon Balm ointment or nitroglycerin ointment. After defecation, patients can opt to use an anal wash or a potassium permanganate solution for sitz baths. However, for chronic anal fissures, it is generally advised to undergo fissure excision surgery as soon as possible, followed by regular dressing changes to promote healing of the wound. If an anal fissure is left untreated for a long time, it can lead to slight narrowing of the anal canal, which requires significant attention.

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Will anal fissures cause bleeding?

As the name suggests, an anal fissure is a condition where the anal canal splits open, forming small ulcers. These splits run parallel to the longitudinal axis of the anal canal and are typically spindle-shaped or oval. They often cause severe perianal pain. The classic clinical signs of an anal fissure include pain, bleeding during bowel movements, and constipation. Thus, anal fissures do bleed, characterized by spotting of blood during defecation or blood on tissue after bowel movements. The blood is usually bright red. The amount of bleeding relates to the depth and size of the fissure but generally does not present as heavy or spurting bleeding like with hemorrhoids, and significant bleeding is rare. The bleeding from an anal fissure can also recur periodically. Therefore, it is important to seek timely medical treatment at a hospital to ensure effective therapy and early recovery.

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Anal fissure: hot compress or cold compress?

During the acute phase of an anal fissure, patients can choose either hot or cold compresses. The clinical symptoms suitable for hot and cold therapy differ. Hot compresses primarily involve the use of herbal washes, where heat helps the medicated solution penetrate the local fissure, promoting healing and contraction of the mucous membrane. The principle behind cold compresses is that, during the acute phase, when the local fissure pain is particularly intense, cold compresses can reduce or alleviate the pain. Besides conservative hot or cold compress treatments, surgery can also be an option after repeated occurrences. The surgical method typically involves an endoscopic loosening procedure. (Use of specific medications should be under the guidance of a doctor.)