How to treat anal fissures and constipation?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 20, 2024
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Anal fissures and constipation are generally accompanying symptoms. When the stool is dry, the patient exerts excessive force during defecation, causing the stool to tear the local anal sphincter and mucosa, resulting in an anal fissure. Prolonged and recurrent anal fissures, due to the contraction of the local anal sphincter, can make defecation difficult for patients, or, because of the severe pain during defecation, patients may avoid defecating. This leads to stool remaining in the intestinal lumen for too long, causing the stool to dry out and further inducing constipation. To treat anal fissures and constipation, it is first necessary to lubricate the stool. One can take oral medications for lubricating the intestines and easing bowel movements or use topical lubricants. Treatment can also be complemented with anal dilation therapy or surgery through endoscopic incision, and applying a traditional Chinese medicine hot compress to the local fissure.

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Characteristics of anal fissure with bleeding

An anal fissure is a small ulcer formed by the full-thickness splitting of the skin of the anal canal below the dentate line. A characteristic of bleeding due to an anal fissure is that it generally occurs along with periodic, tearing-like pain. Thus, bleeding and pain are the main clinical manifestations of an anal fissure. During defecation, the damaged surface can lead to bleeding from the fissure, usually with a small amount of blood. The stool may have streaks of blood, or there might be a few drops of fresh blood after defecation, or a slight smearing of fresh blood on toilet paper during wiping.

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Are anal fissures and hemorrhoids the same thing?

Hemorrhoids and anal fissures are common clinical conditions, but their symptoms are completely different. Generally, they both share a common symptom, which is the presence of rectal bleeding, and this bleeding is usually bright red blood. The difference between anal fissures and hemorrhoids is that anal fissures primarily cause pain, while hemorrhoids primarily cause bleeding. Hemorrhoids only cause severe pain when external hemorrhoids become inflamed and swollen, while anal fissures often involve enlargement of the anal papillae. Hemorrhoids do not involve enlargement of the anal papillae, and while anal fissures can involve skin tears around the anal canal, hemorrhoids do not. During a digital rectal exam, this can be diagnosed; hemorrhoids are caused by poor local venous circulation, leading to venous congestion and the formation of vascular bulges. Depending on their location, they are divided into internal and external hemorrhoids. Anal fissures are skin tears located on the more lateral parts of the anus, and during defecation, the tear worsens, bleeding and causing severe pain, whereas hemorrhoids usually do not cause severe pain.

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What is an anal fissure?

What is an anal fissure? In clinical practice, we often encounter patients asking this question. An anal fissure is a crack in the skin around the anal canal; simply put, it is a split in the skin at the anus. The direction of the split aligns with the direction of the anal skin's folds. Of course, not all cracks in the anal skin are called anal fissures. It is only considered an anal fissure if there is a full-thickness split in the skin at the anus. If it is a superficial skin split, it is referred to as an anal skin laceration or fissuring, such as those caused by certain anal itching diseases, which are in fact fissures in the anal skin. Anal fissures commonly occur at the “anterior and posterior midline” of the anus, which is similar to the directions of 6 o'clock and 12 o'clock as described on a clock face. Doctors often describe these as positions at 6 o'clock and 12 o'clock.

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How to improve anal fissure bleeding?

To improve anal fissure and bleeding, the first step is to treat constipation by softening the stool, as most anal fissures are caused by dry stools tearing the local skin and mucous membranes of the anus, leading to bleeding from these tears. For those experiencing pain and bleeding due to anal fissures, it is advisable to apply sesame oil around the anus before each bowel movement to prevent irritations from stool aggravating the fissure, which can cause recurrent pain and bleeding. After defecation, hemorrhoid cream can be applied for hemostatic treatment, and medicinal herbal solutions can be used for local compression and hot compresses to promote the growth and healing of the fissure. (Note: Medications should be used under the guidance of a doctor.)

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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.