Category Archives: Anal fissure

Understanding and Managing Chronic Anal Fissures

Introduction
Chronic anal fissures can be a source of discomfort and embarrassment for those who suffer from them. While they may not be a common topic of conversation, these painful tears in the lining of the anus affect a significant number of people. In this blog, we will explore what chronic anal fissures are, their causes, symptoms, and most importantly, how to manage and treat them effectively.

What is a Chronic Anal Fissure?
An anal fissure is a small tear or crack in the lining of the anus, and when it persists for more than six weeks, it is classified as chronic. These fissures are typically located in the posterior midline of the anal canal and are a common cause of anal pain and discomfort.

Causes of Chronic Anal Fissures

  • Straining during bowel movements: One of the primary causes of anal fissures is the excessive straining during bowel movements. This can result from constipation, hard stools, or prolonged diarrhea.
  • Anal trauma: Injury to the anal area, such as from rough wiping, can cause fissures to develop.
  • Anal sphincter muscle problems: High resting anal tone or spasms of the anal sphincter muscles can lead to reduced blood flow to the anus, making it more susceptible to fissures.
  • Inflammatory bowel disease: Conditions like Crohn’s disease or ulcerative colitis can increase the risk of developing anal fissures.
  • Pregnancy and childbirth: The strain on the anus during childbirth can lead to fissures, which can sometimes become chronic.

    • Symptoms of Chronic Anal Fissures
    Chronic anal fissures often present with the following symptoms:
    Pain during bowel movements: This is usually the most prominent symptom. The pain can range from mild to severe and can last for hours after defecation.
    Bleeding: Bright red blood on toilet paper or in the stool is a common sign of anal fissures.
    Itching and burning: Some individuals may experience itching and burning around the anal area.
    Spasms: Painful spasms of the anal sphincter muscles can occur, making the pain even more unbearable.

    Managing and Treating Chronic Anal Fissures
    Fortunately, chronic anal fissures are treatable, and in many cases, they can heal without the need for surgery. Here are some strategies for managing and treating chronic anal fissures:

  • Dietary changes: Maintaining a high-fiber diet can help soften stools and prevent constipation, reducing the strain during bowel movements. Adequate water intake is also essential.

    • Topical treatments: Over-the-counter creams or ointments containing ingredients like hydrocortisone or nitroglycerin can help relax the anal sphincter muscles and promote healing.

    Sitz baths: Soaking in warm water for 15-20 minutes several times a day can provide relief and promote healing by improving blood flow to the area.

    Stool softeners: In some cases, your doctor may recommend stool softeners or laxatives to prevent straining during bowel movements.

    Prescription medications: If over-the-counter treatments are ineffective, your healthcare provider may prescribe stronger medications or creams.

    Botulinum toxin injection: In cases of severe anal sphincter muscle spasms, botulinum toxin (Botox) injections may be used to relax the muscles temporarily.

    Lateral internal sphincterotomy: Surgical intervention, such as a sphincterotomy, may be necessary if conservative treatments fail. This procedure involves cutting a small portion of the anal sphincter muscle to relieve pressure and promote healing.

    Conclusion
    Chronic anal fissures can be painful and disruptive, but with the right approach to management and treatment, most people can find relief and allow their fissures to heal. It’s important to consult with a healthcare provider for an accurate diagnosis and to discuss the most appropriate treatment plan for your specific case. Remember, early intervention and lifestyle modifications can often prevent chronic anal fissures from recurring, ensuring a better quality of life for those affected by this condition.

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    How Botox Can Help Treat Your Chronic Anal Fissure | Minnesota

    While Botox is often associated with battling wrinkles and fine lines on the face, the medication can actually be used in your…anal region. But not for cosmetic purposes, of course.

    The muscle-relaxing effects of botulinum toxin can do wonders for patients suffering from painful anal fissures, an anorectal condition that produces sharp rectal pain during bowel movements due to a tear in the anal canal. Typically caused by hard bowel movements or a lack of dietary fiber, fissures usually resolve on their own after responding positively to increased fiber intake, stool softeners, ointments and sitz baths. However, when a fissure fails to heal within six weeks (thereby becoming a chronic fissure), a Botox injection is most likely the preferred plan of attack.

    Because Botox blocks the release of acetylcholine, a chemical that causes muscles to contract, injecting it into the muscle surrounding the anus will relax those muscles and reduce tension. Not only does this decrease pain and discomfort, but it also improves blood flow to the fissure, helping it heal more quickly and naturally.

    Requiring no anesthetic and only a few minutes on the exam table, the Botox procedure involves 6-8 consecutive injections into the sphincter muscle using a hair-thin needle. And then, you’re done! Patients can simply head home and wait for the Botox to start working after 2-3 days. There usually aren’t any side effects, although slight bleeding/pain and gas incontinence can occur.

    Effects should last for at least three months—plenty of time for the fissure to fully heal on its own. With a roughly 70 percent success rate, Botox is a highly preferred method for treating chronic, painful anal fissures.

    For more details on what happens before, during and after a Botox injection procedure, click here. If you find yourself dealing with a chronic anal fissure, please contact our clinic for treatment options.

     

    Posted in Anal fissure, Anorectal Care, Anorectal Diseases | Tagged Tagged , , , , , ,

    Try These 8 Tips to Relieve Constipation | Minnesota

    Constipation is one of the most common bowel disorders affecting American adults, with roughly 20 percent of the population suffering from hard, painful stools. Defined as having fewer than three bowel movements per week for several weeks, constipation occurs when the colon absorbs too much water from the food passing through it, creating dry stool that’s extremely difficult to pass.

    While constipation is never pleasant, there are a few ways to manage and improve symptoms so that other complications—like hemorrhoids—don’t set in. Below are a few tips for boosting your bowel movements:
     
    1. Eat more apples – This juicy fruit is packed with pectin fibre, which has been found to help relieve constipation and slow down the absorption of excess dietary fats, making you feel fuller for longer. The sorbitol in apple juice also has a laxative effect.

    2. Eat more raisins and figs – If apples aren’t your thing, perhaps these two dried fruits can be added to your diet. High in fiber, raisins and figs are even more beneficial to your digestive system when soaked in water.

    3. Exercise more – Being more active is always beneficial to your health! Hitting the gym or simply going for a jog outside helps aid food breakdown and reduce the time it takes food to move through the large intestine. The less time food sits in your colon, the more water it retains to help ease stool passage later.
     
     
    4. Hydrate – Retaining water in your stool is the key takeaway here, so drinking more fluids is critical. When you don’t drink enough water, your body absorbs more water from the food you eat in order to make up for the imbalance.

    5. Try over-the-counter medications – For a quicker fix, laxatives (used in moderation) can help with constipation. These substances work to loosen your stools and increase bowel movements pretty quickly.

    6. Don’t hold your poop – If you feel even the slightest urge, go to the bathroom! Holding your bowel movements causes stools to sit longer in the colon, increasing the amount of water absorbed. Definitely not what we want!

    7. Drink some coffee – Despite being a diuretic that can dehydrate you if consumed in large quantities, coffee has been shown to stimulate the muscles in your digestive system. Small amounts of soluble fiber in coffee can also boost the balance of your gut bacteria.

    8. Try probiotics – Studies have shown that Bifidobacterium, a bacteria of the gastrointestinal tract, can aid in digestion and reducing constipation. Yogurt, fermented vegetables (kimchi, miso, sauerkraut), cured meats, vinegar and sourdough bread are good options for increasing your probiotics intake.

     

    Posted in Anal fissure, Anal fistula, Anorectal Care, Anorectal Diseases, External Hemorrhoid, Hemorrhoid, Hemorrhoid prevention, Hemorrhoids, internal hemorrhoids, Rectal bleeding, rectal pain | Tagged Tagged , , , , , ,

    The Many Causes of Anal Skin Tags | Minnesota

    While anal skin tags are extremely common, they’re very rarely cause for alarm. These non-cancerous, benign small bumps or raised areas around the anus are essentially excess skin growths that develop for various reasons. They’re usually sensitive to the touch and can be quite itchy, but aren’t usually painful. While some individuals seem to be genetically prone to developing skin tags, a variety of causes ranging from skin friction to hemorrhoids may be linked to skin tag formation.
     

    Who gets anal skin tags?

    Anal skin tags can affect anyone, but they’re much more prevalent in obese individuals and individuals who suffer from chronic bowel problems, especially Crohn’s disease. Additionally, pregnant women tend to develop skin tags more easily due to hormone fluctuations and increased skin friction around the anal region. Those who suffer from hemorrhoids or inflamed lesions and anal injury are also at a higher risk of having anal skin tags.
     

    How do anal skin tags develop?

    Although the exact causes of skin tags are unclear, they usually result from one or more of the following:

  • Hemorrhoids – When swollen hemorrhoids begin to shrink and eventually heal, excess skin may remain and form into a skin tag.

  • Diarrhea – Also related to friction, having recurrent bowel movements can irritate the skin around the anus, especially if combined with excess wiping.

  • Constipation – Too many bowel movements can lead to skin tags, as can too few bowel movements. When you overstrain, the anal blood vessels can swell and bulge; skin near the anus must also stretch to accommodate large or hard stools. Skin tags form when the skin fails to snap back to its original position.

  • Friction/irritation – Increased friction between surfaces of the skin, such as from exercising or prolonged sitting, can lead to anal skin tags.

  • Crohn’s disease – Sufferers of this chronic bowel disorder experience inflamed intestines and bouts of diarrhea and constipation, all of which contribute to a higher risk of skin tags.

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    How can I prevent anal skin tags from forming?

  • Decrease the chances of constipation and diarrhea by eating plenty of fiber and keeping your bowel movements regular.

  • Do not excessively wipe after a bowel movement to avoid excess friction and irritation.

  • Do not wear overly tight underwear, which can cause skin irritation and unnecessary friction while moving or sitting.

  • Aim for a healthy body weight and avoid a sedentary lifestyle. Overweight and obese individuals are more prone to developing skin tags, so eating a balanced diet and regularly exercising can significantly lower your risk.

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    Posted in Anal fissure, Anal itching, anal tags, Anorectal Care, Anorectal Diseases, External Hemorrhoid, Hemorrhoid, Hemorrhoids, internal hemorrhoids | Tagged Tagged , , , , , ,

    10 Reasons For Rectal Bleeding That Aren’t Hemorrhoids | Minnesota

    Bleeding from your rectum or anus is never a pleasant experience, and it can understandably cause immediate panic. Generally, bright red blood indicates bleeding in the lower rectum, while dark red blood indicates bleeding from deeper and further up in the body. While passing dark red blood is usually a sign of digestive bleeding and requires immediate attention, any amount of rectal bleeding should be taken seriously.

    While rectal bleeding can be caused by pesky hemorrhoids, there are a number of other potential causes ranging from fistulas and fissures to more serious cases of colon/bowel cancer.
     
    1. Anal Fistula
    An anal fistula is an inflammatory tunnel under the skin connecting the anal canal and the surface of the surrounding skin. Most fistulas occur from an anorectal infection, where the anal crypts are infected and cysts containing pus form near the anal canal. Fistulas are often misdiagnosed as hemorrhoids, as symptoms can be similar, including drainage from the anus, itchiness and pain during bowel movements. They can be treated with antibiotics, pain meds and a fistulotomy.

    2. Anal Fissure
    An anal fissure is a small rip or tear in the lining of the anal cana typically caused by trauma to the inner lining of the anus via a bowel movement or stretching of the anal canal. They can be painful, but fissures often heal within a few weeks through increasing fiber/fluid intake to keep stool soft and help ease bowel movements.

    3. Colon Cancer
    As scary as it may sound, rectal bleeding is a dangerous sign of colon cancer and must be taken very seriously. Symptoms of colorectal cancer include abdominal pain, a change in bowel habits, an anal or rectal lump, and bleeding during bowel movements. Click here to read our post on the differences between rectal cancer and hemorrhoids.

    4. Gastroenteritis
    Gastroenteritis, otherwise known as the stomach flu, is a common bacterial infection that causes diarrhea, fever and vomiting. Due to inflammation in the stomach and colon, the bowel becomes more sensitive during the illness and may cause bloody stools. While the process is uncomfortable, gastroenteritis normally clears up after a few days of rest and hydration.

    5. Diverticulosis
    Diverticulosis is a chronic bowel condition that causes small bulges or pockets to develop in the lining of the intestine/digestive tract. If these bulges become inflamed or infected, abdominal pain, bloating, constipation, diarrhea, and bloody stools can occur. More common in people over 40, diverticulosis can be treated using diet modifications, antibiotics and, if needed, surgery.

    6. Rectal Prolapse
    Believe it or not, a bit of your intestine can actually slip outside of your body. A rectal prolapse occurs when part of the large intestine slips outside the anus, which can happen during a bowel movement. This in turn causes pain and bright red blood in the stool, as well as difficulty in controlling your bowel movements. A prolapse usually requires surgical treatment, so call your doctor right away.

    7. Polyps
    Polyps are non-cancerous growths that can develop along the lining of your bowel. They’re pretty common and don’t usually manifest symptoms. In more severe cases, they can cause diarrhea, constipation, mucus in the stool and bloody stools. While most polyps do not escalate into cancer, there is still risk of cancer development. Be sure to call your doctor for a full examination.

    8. Internal Bleeding
    As mentioned earlier, darker colored blood can be a sign of internal bleeding in your digestive system. It can also be a sign of cancer, stomach ulcers or severe gastrointestinal disease. If you see dark red blood in your stool call your doctor ASAP.

    9. Colitis
    Colitis is a chronic inflammation of the innermost lining of the large intestine and rectum. Small ulcers develop in the lining of the bowel, which then bleed and produce pus. This causes recurring diarrhea, abdominal pain, rectal bleeding, and the frequent urge to pass stools. Management of colitis conditions can include antibiotics, medications and surgery.

    10. Sexually Transmitted Infection (STI)
    Sexually transmitted infections (STI) can result from unprotected anal sex and cause inflammation of the lining of the anus, which can lead to bleeding and pus. Treatment includes antibiotics and antiviral/antifungal medications.

     

    Posted in anal abscesses, Anal Cancer, Anal fissure, Anal fistula, Anal lump, Anorectal Diseases, External Hemorrhoid, Hemorrhoid, Hemorrhoids, internal hemorrhoids, Rectal bleeding, rectal lump, rectal pain | Tagged Tagged , , , , , ,

    How to Treat if I Have Both Hemorrhoids and an Anal Fissure? | Minneapolis & St Paul

    The patients in Minnesota often couldn’t tell the differences between anal fissure and hemorrhoids because they both cause rectal pain and rectal bleeding at the same location. Although both hemorrhoids and anal fissure are associated with similar symptoms, they are two very different diseases that are important to distinguish.

    Hemorrhoids could be as painful as anal fissure when thrombosis develops. In the most time, the pain caused by hemorrhoids is mild, persistent, dull aching pain, not always related to bowel movement. Anal fissure usually has sharp rectal pain during bowel movements.

    An anal fissure is a tear in the anal canal in the lower rectum. Anal fissures are typically thought to be caused by trauma from a hard or painful bowel movement. Many patients report bright red blood on the toilet paper or the stool, though bleeding is usually not significant.

    If hemorrhoids and anal fissures occur together, the patients have to treat anal fissure first. Not only is anal fissure more painful, but also is hemorrhoids usually treated under anoscope which creates more pain and makes anal fissure worse.

    Hemorrhoids and anal fissures are initially treated with high fiber diet (such as fruits, veggies and whole grains) , taking an over-the-counter stool softener and using creams or ointments especially for hemorrhoids. It can also help to soak your bottom in warm water for 2-3 times a day, and Sitz baths after bowel movements are effective in relieving symptoms.

    If these first-line treatments do not work, the patient will focus on the definitive treatments for anal fissure with the topical agents such as Nifedipine and nitroglycerine (NTG) ointment in conjunction the treatments listed above.

    Botox has also shown to be a promising treatment, its relaxation effect on sphincters lasts for three months that is long enough for anal fissure to heal. If the anal fissure does not resolve following treatments, then a partial anal sphincterotomy may be needed, where a cut will be made on the anal sphincter in a different location in the anus, and both the fissure and new cut will heal together.

    After anal fissure heals, the attention turns to treat the hemorrhoids with infra-red coagulation, banding or surgery if necessary.

    Posted in Anal fissure, Hemorrhoid, hemorrhoid clinic, hemorrhoid doctor, Hemorrhoid treatments, Hemorrhoids | Tagged Tagged , , , , , ,

    Injections of Botulinum toxin for Anal Pain and Anal Fissure

    Introduction
    Botulinum toxin A, is a toxin protein produced by bacteria called clostridium botulinum. When injected into a muscle, it will temporarily blocking neural signals for muscle contractions, causing the muscle fibers at the injection area to relax. Botulinum toxin A has been successfully used for the treatment of a variety of medical conditions involving unwanted muscle spasms such as strabismus and cervical dystonia. It is also commonly used for removing unwanted wrinkles in cosmetic care.

    The internal anal sphincter that controls the anus is always under tension. If this tension (also called resting pressure) is too high, it causes rectal pain. The common diseases associated with anal sphincter spasms are anal fissure and functional anal rectal pain. Spasm can make an anal fissure worse or prevent an existing one from healing.

    Botulinum toxin A has also been used to treat anal fissure for several years. Injecting Botulinum toxin A into muscle around the anus will temporarily relax the internal anal sphincter. This reduces the spasm and pain and allows the fissure to heal.

    Most patients have at least some pain relief in their pain after treatment with Botulinum toxin A. The success rate for an anal fissure healing after the injection is 70 out of 100 treatments. Sometimes the injection might need to be repeated, especially in the patients with functional anorectal pain.

    What Happens During the Procedure?
    There is no special preparation needed before the injection procedure. You don’t need to do any preparation, but you are encouraged to have bowel movement and please do carry out your usual hygiene routine (shower or bath) before you come in.

    Dr. Shu will perform the injection procedure in the exam room or procedure room, and it takes a few minutes to perform. You will be awake throughout the procedure.

    You will be asked to lie on your left side on the exam table. The area around your anus will be cleaned with an alcohol spray. Dr. Shu will then give 6-8 injections of Botulinum toxin A into your sphincter muscle with a hair thin needle. This will be uncomfortable during the injection, but it is an extremely quick procedure.

    After the Procedure
    You can drive home or return to work afterwards. Very occasionally, the patient develops vasovagal reaction (fainting) to the procedure, the you lie on the table for a few minutes to recover.

    The Botulinum toxin A will start to work in a few days. The effects of Botulinum toxin A peaks in 1-2 weeks and usually lasts 3-6 months. During this time, anal fissures are allowed to heal.

    Most people do not have any side effects. The potential side effects of botulinum injections may include the inability to control the passage of gas (gas incontinence), pain from the injections, bleeding, infection at the injection site, and rarely, fecal incontinence (we don’t have any case of fecal incontinence). If symptoms of incontinence occur following Botox® injection, they typically disappear completely after several months.

    It is important to make sure that you continue to keep your stool soft following the treatment, to avoid straining. Continue anal care measures including Sitz bath, fibre in your diet, and drinking enough water.

    Posted in Anal fissure, Anorectal Diseases, Hemorrhoid, Hemorrhoid Care, hemorrhoid clinic, hemorrhoid doctor, rectal pain | Tagged Tagged , , , , , , , , ,

    How to Differentiate Anal Fissure from Hemorrhoids | Minneapolis & St Paul

    The patients in Minnesota often couldn’t tell the differences between anal fissure and hemorrhoids. Although both hemorrhoids and anal fissure are associated with rectal pain and rectal bleeding, they are two very different diseases that are important to distinguish.

    Hemorrhoids could be as painful as anal fissure when thrombosis develops. In the most time, the pain caused by hemorrhoids is mild, persistant, dull aching pain, not always related to bowel movement. Anal fissure usually has sharp rectal pain during bowel movements.

    Anal Fissure
    An anal fissure is a tear in the anal canal in the lower rectum. Anal fissures are typically thought to be caused by trauma from a hard or painful bowel movement, and are often associated with a lack of fiber in the diet. Symptoms include severe rectal pain during bowel movements, which can last from minutes to hours after. The pain is worse with constipation, which may occur if the patient has been avoiding bowel movements due to pain. Many patients report bright red blood on the toilet paper or the stool, though bleeding is usually not significant. If a fissure persists over time it may become a chronic fissure.

    Anal fissure require anoscopy as it cannot be directly observed visually. However, anoscopy is quite painful for those with an anal fissure so a doctor may treat it based on symptoms alone. About 80% of fissures resolve themselves without the need for surgery. Initial treatment is generally conservative in nature, with the goal of relieving constipation and breaking the cycle of hard bowel movements. Patients may take stool-bulking agents like fiber supplements and stool softeners, as well as laxatives to encourage regular bowel movements. Mineral oil can serve this purpose as well, but it is not advisable to be used indefinitely. Sitz baths after bowel movements are effective in relieving symptoms.

    If these first-line treatments do not work, the patient may be directed to use 0.4% nitroglycerine (NTG) ointment in conjunction the treatments listed above; however, this is generally not preferred as NTG ointment can cause adverse side effects like headache and dizziness. Alternatively, Nifedipine gel is a better option to treat anal fissure.

    Botox has also shown to be a promising treatment, its relaxation effect on sphincters lasts for three months that is long enough for anal fissure to heal. If the anal fissure does not resolve following treatments, then a partial anal sphincterotomy may be needed, where a cut will be made on the anal sphincter in a different location in the anus, and both the fissure and new cut will heal together.

    Posted in Anal fissure, Anorectal Diseases, Hemorrhoid, hemorrhoid clinic, hemorrhoid doctor, Hemorrhoids, rectal pain | Tagged Tagged , , , , , , , , , ,
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