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Gastroenterology  (Expert Forum)
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Anal Fissure
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Anal Fissure

by MarieJ, Apr 13, 2003 12:00AM
I have been constipated the last couple of weeks.  I took some Senokot last Tuesday to help with this.  Then on Wednesday I had a bowel movement.  It was really hard to pass the stools.  I noticed there was blood on my stools and on the toilet paper.  I went to a doctor the same day and was told it was an anal fissure.  The doctor gave me hydrocortisone suppositories.  I took these for a couple of days, but had to stop using them because it was too painful to use them.  Also, that same day I drank some prune juice.  This caused me to have diarrhea, which worsened the pain.  Ever since Wednesday I have been in so much pain I have not been able to sit up, therefore have not been able to work.  I have to lay on my side, I cannot even ride in a car. The pain is constant, not just when having a bowel movement.  I have increased my fiber intake and fluid intake and now I'm having 1-2 soft bowel movements per day. I have been taking 3-4 tub baths in plain warm water a day.  I have tried using hydrocortisone cream and anesthetic cream.  None of this seems to be helping.  I also noticed something strange when I was applying the cream.  It looks like there is something hanging from my anus. I can't tell if it is skin or a hemorrhoid, but the doctor did not mention it.  I also feel constant pressure there, like something is pushing down on me.  I haven't noticed anymore blood in my stool.  And yesterday I started to have itching and burning (like I'm on fire) there also.  I'm not sure what to do.  How long do fissures take to heal?  How long do they take to stop causing so much pain?  I can't miss anymore work from this, but I can't even sit up.  I'm typing this standing.  Could I have something else going on with me besides a fissure? Thanks.
Doctor's Answer

by Kevin Pho, MD, Apr 14, 2003 12:00AM
Hello - thanks for asking your question.



Hydrocortisone is not normally effective for anal fissures.  



Topical nitroglycerin increases local blood flow and reduces pressure in the internal anal sphincter, which may further facilitate healing.  In studies, the median time of healing was 6 weeks.



Another form of therapy is botulinum toxin.  Injection of botulinum toxin into the anal sphincter can improve healing in patients with chronic anal fissure.  Time to healing in these studies were approximately 2 months.  



The ability of oral nifedipine to reduce resting internal anal sphincter pressure prompted its use for the treatment of patients with chronic anal fissures.  Treatment was associated with an initial reduction in maximum anal resting pressure and pain scores.  Time to healing in these studies were approximately 2 months.  



If these medical therapies do not help, then the next option would be surgical.  In trials, surgery has proven to be more effective than medical therapy.  



As for the question of possibilities other than a fissure, other considerations may include a colorectal mass, inflammatory bowel disease, or hemorrhoids.  Endoscopy would normally diagnose these conditions.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (17)

by midsummer, Apr 13, 2003 12:00AM
Hello. I have suffered with anal fissures for over 7 years.

If the problem gets too bad then GTN ointment 0.2% is a good help.

Lots of baths also.

I have had surgery but it did not help.

If this is the first time you have had a problem then I wouldnt worry to much, they do generally take time to heal.

I would check the other problem out again though..hope this helps.

by nadia, Apr 13, 2003 12:00AM
I have a family member who suffered tremendously with bleeding anal fissures.  It went on for about 8 months.  The only thing that worked(and she tried everything from perscription cream to suppositories) was 1.5 tbs of cold pressed extra virgin olive oil (drank) and metamucil.  I have since found out that olive oil also helps keep the gallbladder clear of stones.  Some doctors suggest mineral oil for constipation, but I would think that this treatment would be much better.

by surgeon, Apr 13, 2003 12:00AM
the "hanging" thing could be what's called a sentinel pile, and is often seen with a fissure. Cortisone ointment doesn't usually do much. Nitroglycerine ointment is much better. If your doctor isn't familiar with using it, perhaps a referral to a surgeon would be useful. When the ointment doesn't do the trick, a simple operation usually does.

by rst, Apr 15, 2003 12:00AM
am havin that same pain too. only thing i noticed is theres a small lump in the outer portion of my butt. checked with my doctor and told me that it was a muscle expanding evrytime i do my bowel. it gets painful when am havin a hard stool or too much bowel movement. sometimes it gets kinda itchy and irritating and i cant sit down too long when it happens cause i feel pain. am concerned with the lump....does anyone out there have had or has this lump just outside the anus. it worries me but the doc says theres nothing to worry bout.

by ribhurting, Apr 15, 2003 12:00AM
About a year ago i went on the Atkins diet and became severely constipated.  Bowel movements were few and far between and extremely large ( pardon the subject ).  As a result, i noticed blood on the tissue and experienced excruciating pain in my rectum.  I thought it was hemmoroids and made an appt. with a surgeon.  He diagnosed me with an anal fissure and gave me a script that seemed to help some, along with 3-4 tub soaks per day which is kind of hard when u work full-time.  Finally, after dealing with not being able to sit more than a few minutes and all of the pain, i went back to him and he said "You need surgery",,,,it's called a spyphincterotomy.  Basically they sew up the tear in your rectum.  Ahhhhhhh,,,the relief,,,2-3 days post op on heavy meds (oxycotin) then darvocet for another 10 days and back to work within 2 weeks.  I could have really returned earlier but had like 300 hours of vacation..my advice,,,,don't go thru the agony,,,they rarely heal themself and just have it taken care of.  Good Luck,,,I know exactly where u are right now.

by ribhurting, Apr 15, 2003 12:00AM
Oh, also,,,,have had absolutely no problem ever since,,,,my surgeon told me,,,"do u know how many people have sat in that chair(across from him) and told me about the Atkins diet?  He said, after the exam  as soon as i explained my symptoms and told him about the atkins diet he knew exactly what he was going to find,,,and did.  Anybody out there going on the atkins diet, drink TONS of water,,,the dehydration causes the large stools.

by rst, Apr 15, 2003 12:00AM
i notice a lump everytime i stress out my bowel movement but otherwise its not there...is this a muscle???

by rst, Apr 15, 2003 12:00AM
well actually i just feel this lump sometimes when my stool is hard.......but at times i dont feel it there...weird but it gets me scared you know.......help anyone??? told my doc bout it and said it was piles or somethin to do with my diet......whheeeew!!!!

by MarieJ