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Health Sense: Painful bowel movement may be a sign of a bigger problem
Are you experiencing pain after bowel movements? You may have an anal fissure
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Are you experiencing pain after bowel movements? You may have an anal fissure.
Pain during or after bowel movements can be attributed to several reasons. You may have developed an anorectal abscess, prolapsed piles or anal fissure.
An anorectal abscess is a collection of pus in the area of the anus or rectum. People with anorectal abscess complain of swelling, pain and tenderness around the abscess region, and this pain may be present throughout the day, with some unable to sit comfortably.
Some people may complain of discharge staining their underwear when the abscess bursts.
In contrast, prolapsed piles do not result in discharge, but a common complaint of those with piles is fresh blood passed out during defecation and a lump or several lumps present at the anus.
In this article, we will concentrate on anal fissures, which are simply put, a tear in the anus.
Anal fissures affect people of both genders and all ages.
They are characterised by pain during bowel movement that may last up to half an hour. There may also be blood stains found on the toilet paper after defecation.
The most common cause of anal fissures is an episode of constipation.
Hard stools accumulate and when bowel movement occurs, trauma to the anus occurs, resulting in a tear. In some cases, anal fissures can also be caused by severe diarrhea.
In sufferers of chronic anal fissure, a small polyp at the anus may develop, known asa hypertrophic anal papilla, which is often mistaken for prolapsed piles.
When an anal fissure is developed, the internal muscle in the anal canal known as the internal anal sphincter tightens and goes into spasm. This makes it even harder to defecate during the next bowel movement. When the anus is forced open, it results in a further tear. The internal anal sphincter further tightens and goes into spasm again, and this vicious cycle continues.
Your doctor will be able to determine if there is an anal fissure during a clinical examination. Most of the time, patients with anal fissure will not be able to tolerate per rectal examination due to severe pain.
Sometimes, the doctor will be able to see the tear during gentle examination. The tear occurs characteristically at the part of the anus closest to the tail bone.
However, if the patient complains of bleeding as well, a colonoscopy would be recommended to eliminate other possible in the colon that may be more serious, especially if the patient is above 50 years old or has a family history of colon cancer.
This is because colon cancer is on the rise and is the most common cancer in Singapore. A colonoscopy involves inserting a small, fibre optic camera into the anus to visualise the insides of the colon.
The main aim of the treatment methods for anal fissure is to break the vicious cycle of anal sphincter spasms and worsening tears.
There are several treatment options. The most conservative approach involves softening of stools using a stool softener known as lactulose.
Patients are also advised to avoid overconsumption of fibre that is not digested easily in initial stages of treatment and increase fluid intake to prevent hard stools from forming. This would allow the fissure to heal.
Second, medication can be applied to the anus to relax the anal sphincters. Hence, the spasm and tightness can be relieved and hence the vicious cycle can be broken. This can be used in accompaniment with stool softeners as well.
For patients with chronic anal fissures, a more permanent surgical option may be suggested.
Known as lateral anal sphincterectomy (LAS), the patient will be put under general anesthesia for a short while and a small 2-millimeter cut will be made at the anus to cut the lowest segment of the internal sphincter and relieve the spasm.
In recent years, botulinum toxin (Botox) injection has become a more popular treatment choice amongst patients. The patient will be under monitored-sedation and botox will be injected to the anal sphincter to relax the muscles. The sphincter will be relieved of spasm from up to six to nine months to allow the tear to heal completely.
Anal fissures can be prevented with a well-balanced diet, adequate fiber and liquid intake.
The writer, a colorectal and general surgeon, has published more than 30 scientific papers in peer-reviewed medical journals. For more information, visit khngsurgery.com.sg.
