Anal fissure bleeding symptoms

Written by Chen Tian Jing
Colorectal Surgery
Updated on October 25, 2024
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The most common clinical symptoms of anal fissure, apart from the intense tearing pain in the anal area, include bleeding during bowel movements. The bleeding from anal fissures is typically bright red, and the amount of blood can increase with the severity of the condition due to repeated stretching of the fissure. Particularly during acute episodes of anal fissures or after defecation, bleeding from the local fissure can be more significant. Patients with bleeding anal fissures generally have a history of dry stools, so the first step in treating anal fissure bleeding is to lubricate the stool. Additionally, topical medications should be applied to the bleeding fissure to promote healing, and hemorrhoid creams with hemostatic properties can be used locally to help stop the bleeding. (Please use medications under the guidance of a professional physician, and do not self-medicate.)

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Written by Li Xiao Jie
Internal Medicine
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Can anal fissures be cured completely?

Anal fissures are a curable condition, so do not worry. Anal fissures are relatively common in clinical practice and are a frequently occurring disease. Fresh anal fissures, which are of short duration and have small fissures, can be treated and cured using methods such as fumigation, oral medications, or rectal insertion. For older, chronic anal fissures, surgical treatment can be administered, including methods like the Milligan-Morgan technique or fissurectomy, all of which can achieve a cure. However, anal fissures are related to lifestyle and dietary habits, so even after healing, it is important to be cautious of various triggering factors to prevent recurrence.

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Written by Chen Tian Jing
Colorectal Surgery
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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 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 Chen Tian Jing
Colorectal Surgery
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What should I do about anal bleeding and anal fissures?

If a fissure is visible to the naked eye at the anal sphincter during a digital rectal examination, it is primarily considered an anal fissure. Anal fissures generally cause severe local pain and bleeding from the fissure. The fissure is primarily due to the local crack being stretched or opened, causing bleeding from small blood vessels, and the blood from the fissure is usually bright red. To treat bleeding from an anal fissure, it is first necessary to soften the stool, as the occurrence of an anal fissure is mainly related to dry stools and difficulty defecating. Once the stool is lubricated, it can reduce the need to exert excessive force during defecation, lowering the possibility of stretching the local fissure. Topical application of hemorrhoid cream at the fissure, or combined with oral medications that cool the blood and stop bleeding, may be used. If there is repeated bleeding from an anal fissure, surgical treatment is also recommended. (Please use medications under the guidance of a professional physician, and do not self-medicate.)

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Written by Hu Xiang Dang
Colorectal Surgery Department
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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.