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 Chen Tian Jing
Colorectal Surgery
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Anal fissure bleeding symptoms

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 Deng Heng
Colorectal Surgery
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What foods should be avoided with anal fissures?

People with anal fissures should avoid consuming chili peppers and alcohol. Chili peppers contain a compound called capsaicin, which can strongly irritate the nerves in the gastrointestinal tract and the ulcers of anal fissures, causing severe pain in the affected area. Additionally, capsaicin can dilate the mucosal blood vessels, leading to bleeding in the anal fissures. Alcohol has a similar effect, as it can exacerbate congestion and blood stasis in the anal and rectal areas. In most cases, consuming chili peppers and alcohol can intensify the pain.

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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 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.

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Written by Chen Tian Jing
Colorectal Surgery
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How to treat anal fissures and constipation?

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.