Anal fissure: hot compress or cold compress?

Written by Chen Tian Jing
Colorectal Surgery
Updated on May 12, 2025
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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.)

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Written by Li Xiao Jie
Internal Medicine
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What should be paid attention to for anal fissures?

The occurrence of anal fissures is highly related to constipation. Therefore, for patients with anal fissures, treating and preventing constipation is the most important approach. It is advisable to eat more vegetables and fruits, consume fewer spicy and stimulating foods, and reduce the intake of greasy foods. The diet should be light, drink more water, and pay attention to local hygiene. Furthermore, patients with anal fissures should avoid sitting or squatting for long periods to prevent aggravating the condition. If symptoms such as fever, difficulty defecating, or severe pain around the anus occur, it is crucial to visit a hospital for examination to rule out other conditions. Regular participation in physical exercise is recommended to promote intestinal movement and facilitate defecation.

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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 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 Wang Ji Zhong
Internal Medicine
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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 Li Xiao Jie
Internal Medicine
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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.