What should be paid attention to for anal fissures usually?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 14, 2024
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Patients with anal fissures primarily develop the condition due to a history of dry stools or straining during early bowel movements. Therefore, it is important for patients to ensure smooth bowel movements and avoid excessive dryness of stools. Diet adjustments should include consuming more bland vegetables and fruits, and avoiding spicy foods such as chili peppers, seafood, and mutton, which are irritants. Additionally, ensuring adequate daily water intake is crucial to prevent dryness in the intestinal feces. Besides dietary and bowel adjustments, patients with anal fissures should actively seek medical treatment during acute episodes to prevent the recurrence of early fissures and the formation of chronic fissures. Early-stage fissures may be treated with topical medications to alleviate symptoms, while chronic fissures may require surgical intervention. (Medication should be administered under the guidance of a doctor.)

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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 Chen Tian Jing
Colorectal Surgery
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What causes anal fissures?

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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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 Chen Tian Jing
Colorectal Surgery
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Can a colonoscopy be performed with an anal fissure?

Patients with anal fissures are advised not to undergo colonoscopy, primarily because the procedure involves inserting the colonoscope through the anus, and anal fissures typically occur within the local sphincter muscles. The passage, or repeated movement, of the probe can cause local fissures to experience painful stimulation, or even worsen the symptoms of the fissures, increasing the likelihood of pain and bleeding for the patient afterwards. Therefore, if patients with anal fissures wish to undergo colonoscopy, they should first receive appropriate medical treatment and wait for the local fissures to heal or be completely cured before undergoing the procedure. If a colonoscopy is necessary, a lubricant can also be applied to the anal region to reduce the irritation of the colonoscope on local fissures.

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Colorectal Surgery Department
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Is anal fissure serious?

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.