What should I do if I have anal fissure bleeding?

Written by Wang Ji Zhong
Internal Medicine
Updated on April 23, 2025
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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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What should I do if I have hemorrhoids bleeding and anal fissures?

Hemorrhoids can lead to local bleeding, and anal fissures can similarly cause bleeding in the local anal area during bowel movements. Therefore, if it is clearly diagnosed as hemorrhoids combined with an anal fissure, and the patient is experiencing bleeding, it is necessary to carry out hemostatic treatment as soon as possible to avoid further exacerbation of bleeding, which may lead to symptoms of anemia in the patient. Both hemorrhoids and anal fissure bleeding can temporarily be managed with oral hemostatic drugs. If the hemorrhoidal bleeding is more severe, direct ligation of the hemorrhoids can be performed. Bleeding from an anal fissure mainly manifests as bleeding from a local fissure, primarily caused by dry stools, so patients with an anal fissure who experience bleeding must receive treatment that softens the stool and facilitates bowel movements. If both hemorrhoids and anal fissures are present and recur frequently, and conservative medication does not easily heal the condition, a mixed hemorrhoidectomy which includes an external peeling and internal ligation surgery combined with a lateral internal sphincterotomy can be performed. (Note: This answer is for reference only. Medication should be taken under the guidance of a professional physician, and one should not medicate blindly.)

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Written by Yu Xu Chao
Colorectal Surgery
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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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Written by Hu Xiang Dang
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What is the best treatment for anal fissures?

How should an anal fissure be treated? It can be addressed from several aspects. First, let's talk about general treatment. What is the principle of our treatment? It is to relieve pain after bowel movements and gradually promote the healing of the fissure. However, the first step is to relieve the spasm of the sphincter, then facilitate bowel movements to interrupt the vicious cycle. But what specific measures are there? One is to take a sitz bath with traditional Chinese medicine for pain relief, such as "Shen Soup," and a 1:5000 potassium permanganate solution after defecation, maintaining local cleanliness. Then, by orally taking some laxatives or paraffin oil, feces can be softened and lubricated. Alternatively, by increasing water intake and eating more fiber-rich foods, constipation can be corrected to keep the bowels clear. In more severe cases, such as those with sphincter spasms, we can perform anal dilation under local anesthesia. By dilating the anus, the spasm of the sphincter can be relieved, and the healing of the fissure can also be promoted. However, this method has a relatively high recurrence rate, and there may also be complications such as severe bleeding, perianal abscess, and fecal incontinence. Anal dilation should be treated by a doctor, and patients should not blindly use it themselves. Of course, there is also surgical treatment. Once an anal fissure has reached a certain degree, generally a chronic anal fissure, many patients need to undergo surgical treatment. Naturally, there are several surgical methods available. We choose different surgical methods according to the condition and severity of the anal fissure. For example, if the patient has an anal fissure that presents with sentinel piles and hypertrophic anal papillae, but there is no anal stricture or internal sphincter spasm, a simple excision of the fissure can be performed. This involves removing the pathological tissue of the fissure, excising the infective anal sinus along with the hypertrophic anal papillae and sentinel piles, allowing the fissure wound to drain openly. However, if there is associated anal stricture, or there is an internal sphincter spasm, we also need to perform an internal sphincterotomy.

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What is the best treatment for anal fissures?

The treatment of anal fissures depends on the specific situation. For initial onset anal fissures, since the fissure is small, treatment can be achieved through methods such as Chinese herbal fumigation or topical application of medicine. For recurrent anal fissures that have persisted for a longer time, fumigation and washing with medicine are less effective. In such cases, surgical treatment is necessary, and it should be sought at the proctology department of a formal hospital. Anal fissures are greatly related to bowel habits, so it is important to maintain smooth bowel movements by, for example, drinking more water, eating more high-fiber foods, consuming less spicy and stimulating foods, abstaining from alcohol, and avoiding greasy foods.

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Colorectal Surgery
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What should I do if my anal fissure doesn't heal?

If an anal fissure consistently fails to heal proactively, it may be due to the repeated expansion of the fissure, or recurrent instances of dry stools and bleeding, leading to ulcerative, infectious changes at the local fissure. This can progress into a chronic anal fissure. Chronic anal fissures have larger local wound surfaces, and the patient may also experience excessive tightness in the anal canal. The local fissure, wrapped within the tightened anal canal, does not drain well, making self-healing impossible. To treat chronic anal fissures, or recurrent fissures, it is recommended to perform a lateral internal sphincterotomy and further debride the local fissure to ensure complete healing of the anal fissure.