HomeAnswersMedical Gastroenterologyanal fissureWhat are the symptoms of an acute anal fissure?

I have rectal discomfort since two weeks and there is no sign of healing. Are these symptoms of cancer?

Share

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Ajeet Kumar

Medically reviewed by

Dr. Sneha Kannan

Published At February 10, 2021
Reviewed AtAugust 30, 2023

Patient's Query

Hi doctor,

I am 36 years old. Since last week, I have been dealing with rectal discomfort. There is no bleeding. I tried to self-check, and the pain is on the back of the rectum, and the discomfort lowers when I lay on my side rather than my back. This discomfort seemed to happen after four straight days of mild diarrhea. I have had a history of soft stool for years with indigested food, but that is getting better with probiotics. I looked at my anus and noticed a skin tag on the rectum, so I wonder if it is a previous anal fissure re-opened? I contacted another doctor online and received Ciprofloxacin and Metronidazole. Please help.

Thanks.

Answered by Dr. Ajeet Kumar

Hi,

Welcome to icliniq.com.

The discomfort or pain can be due to a small anal breach or an acute anal fissure. I do not think that it is a previous anal fissure that has re-opened because that would have caused excruciating pain and usually causes bleeding. An acute anal fissure is common with diarrhea, repetitive washing, and using water jet while washing.

Skin tags, however, are a common finding in the perianal (around the anus) area. And they can be single or multiple. Multiple skin tags can be due to infection like human papillomavirus (HPV) or can simply be due to skin overgrowth. But generally, these skin tags are harmless.

I do not think Ciprofloxacin and Flagyl (Metronidazole) are actually required. You can use the following regimen:

  1. Xylocaine 2 % gel for local application with a finger or a nozzle provided with the package thrice daily.
  2. Diltiazem gel (Diltiazem Hydrochloride) or Glyceryl Trinitrate (GTN) with finger thrice daily.
  3. Fill a water tub with semi-warm water up to half, add Savlon or Dettol and sit into it for 5 minutes (two to three times) daily.
  4. Use Isabgol husk to keep stools formed and soft, take it with water and a little bit of sugar. This will improve your diarrhea.
  5. You can use an oral rehydration solution (ORS) in 1 liter of water twice daily for one to two days till your diarrhea settles.
  6. If you still have diarrhea or repetitive loose bowel movement, you can use Tab Mebever 200 mg (Mebeverine Hydrochloride) only as per need before meals.

I hope this will help you.

Patient's Query

Thank you doctor,

Is cancer in the conversation?

Answered by Dr. Ajeet Kumar

Hi,

Welcome back to icliniq.com.

No, it is not. With this short history of your symptoms and no blood in stools, it is less likely to be cancer. This seems to be acute anal fissure, and I believe you would be alright with the above regimen.

Patient's Query

Hi doctor,

Thank you for the response.

But when I go to the restroom, it does not hurt, but it feels sore after some time.

Answered by Dr. Ajeet Kumar

Hi,

Welcome back to icliniq.com.

Yes absolutely. These are the symptoms of acute anal fissure.

Blood may or may not come, but it is a pain that comes and goes every time you open your bowel or examine it. I suggest you not examine it again and again, since a slight stretching of the anal canal with a finger or otherwise would delay its healing, can bring pain, and can even worsen it more. For the ointment application, gently put the cream in the anal canal without rubbing it or use a nozzle instead.

Patient's Query

Thank you doctor.

Do you know how long the healing will take? It has been almost two weeks since it began. And should I not be worried about cancer? As a hypochondriac, I keep thinking the worse. A doctor visit should ease my mind, but I did not go due to the pandemic. Lastly, do you know what causes feces to break apart in the water? It comes out normal, then it begins to deteriorate and appears like dust.

Answered by Dr. Ajeet Kumar

Hi,

Welcome back to icliniq.com.

The healing time varies from one to six weeks. Usually it takes two to three weeks. I can understand your concern, but I do not think by any means that this is cancer. So please do not be worried about this. It is normal for feces to get apart when they drop in to the water, and there is no abnormality which is related to this. It is normal. I suggest you to start using the treatment as advised above and let me know in a week time to update how you respond.

Patient's Query

Hi doctor,

Thank you for the response.

Does anal fissure include the feeling of muscle contraction at the rectum? When I walk, sometimes my rectum and perineum muscles contract. I am not sure if this is anxiety related or from the fissure. I put Preparation H on the site, but it had witch hazel, and it made it burn and was painful for hours after. This is because I cannot find the medicine you recommended without a prescription. Is the sign of burning a symptom of fissure? I know it cannot be cancer because something like SCC would be ulcerated but also very hemorrhagic. Am I right? It is hard to heal as long as I have diarrhea because I continue to do so, and it seems worse with the Ciprofloxacin I am taking. I stopped taking Metronidazole, but maybe I should go back for diarrhea?

Sorry for all the questions.

Answered by Dr. Ajeet Kumar

Hi,

Welcome back to icliniq.com.

But I do not think that Metronidazole (antibiotics) and Ciprofloxacin (antibiotics) would improve your diarrhea. These acute diarrhea are usually self-limiting and go away by themselves. You have not been taking Isabgol husk (dietary fibers), ORS in the required amount; otherwise, your diarrhea would have settled by now. SCC (squamous cell carcinoma) does not develop in a week, and as classical teaching, cancers always appear as painless nodule or cause painless bleeding. In your case, it is short duration and extremely painful, which both are against the diagnosis.

But to further ease your concern, a digital rectal examination of this area, after your diarrhea and pain settles, is the next best approach. A gastroenterologist would do a digital rectal exam and use a proctoscope to see inside your rectum. We would be in a better position to address your concern. But as of my experience is concerned, it is improbable to be an SCC.

Yes, that cream could have caused this burning, kindly do not use it again. See if Glyceryl trinitrate GTN cream,Xylocaine (lignocaine) 2% gel and Diltiazem (calcium channel blocker) gel are available.

Yes, the rectum and anus both contain muscles, and this muscle often goes in spasm whenever there is injury or inflammation in this area. The pain produced is the product of skin breach and muscle spasms. That is the reason Diltiazem or GTN like cream removes the spasm, and Xylocaine cause desensitization of the nerves to reduce pain.

Patient's Query

Thank you doctor for the reply,

So, I was able to obtain the fiber and ointment you recommended. My main issue now is the pressure in my rectum; it feels like muscle contraction and urges me to defecate because of it. My stool has become more normal due to the fiber. I am starting to think it is a pelvic floor dysfunction rather than a fissure, but I am not certain. It is like levator ani syndrome... just an annoying clenching that leads to a burning sensation, and when I go to the restroom, I defecate. I received a Mebeverine capsule. Is it the same as the Mebeverine tablet?

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

The levator ani syndrome, pelvic floor dyssynergia, or anismus are all the same condition. It does not develop over a few weeks, and usually, the main symptom of anismus is constipation. I feel this is proctitis, i.e., inflammation of the rectum, which can cause a feeling of urgency to defecate repetitively. This inflammation can be infectious-related. A five-day antibiotic course would resolve this inflammation or infection. I suggest you take, tablet Ciprofloxacin 500 mg twice daily and tablet Metronidazole 400 mg thrice daily. Both for five days. You can continue the fiber and ointments for now. Consult your specialist doctor, discuss with him or her, and take the medicines with their consent.

Thank you.

Patient's Query

Thank you, doctor, for the reply,

It seems that as one issue improves, another one arises in its place. I stopped taking Ciprofloxacin and Metronidazole days ago. I have been experiencing loose stools that have become mucusy and yellow in color. I have been defecating three times a day compared to just once a day before. I also stopped taking fiber a couple of days ago because I thought it might be causing an increase in bowel movements.

I still have this odd tension in my pelvic floor when walking, and it is all I think about during walks. My anxiety is worsening, especially after reading that these symptoms could be signs of pancreatic, liver, or rectal cancer. I know a doctor's visit is necessary, but my appointment is not until March. Do you think I might have cancer?

Please assist.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

It is very unlikely to be cancer given the short duration of symptoms, absence of pain, and no bleeding in stools. Infections of the rectum can cause diarrhea, a repetitive urge to pass stools, painful feelings in the rectum, and mucus formation. Both symptoms of increased bowel movements and experiencing urgency, fullness or discomfort, and mucus in stools seem to be due to proctitis, i.e., inflammation of the rectum.

Infections are a common cause of proctitis. However, less common causes such as ulcerative proctitis, which is a condition called ulcerative colitis (UC) when it affects only the rectum, should be considered if symptoms do not resolve after four to six weeks from the onset of initial symptoms. Ulcerative colitis is an autoimmune condition that causes ulceration of the entire colon.

I suggest you check for some stool tests and let me know. There is no urgent need to visit a doctor at the moment. You can wait. You should continue taking fiber in water daily. You can start tablet Mebeverine 200 mg half an hour before meals twice daily. The main side effect of this medication is constipation. So, you can decrease the dose to once daily if constipation occurs.

Thank you.

Investigations to be done

Investigations include: 1. Stool detail report. 2. For ova parasites, stool calprotectin test. 3. Blood for IHA (indirect haemagglutination) titer for Entamoeba histolytica.

Regarding follow up

Follow up with tests.

Patient's Query

Thank you, doctor, for the reply,

I have not had time to complete your tests. I feel like the tension in my rectum has improved, but it is strange that I have these urgent desires to defecate. Typically, I have a bowel movement first thing in the morning, then another around 12 pm. It has been the same time every day for the past week. Previously, it was usually just once in the morning or maybe twice if I ate something unusual. I never felt an urgency to go until this week. Sometimes, I even go three times a day now. Essentially, I do not want to defecate, so I hold it in until the next morning.

The fiber has made my stool firm, which is great, but I dislike that I am going more than once a day. I wonder if this is the new normal. The feeling of tenesmus is really anxiety-provoking, but there is no weight loss or bleeding, just soreness in the rectum. The NGN ointment helps with the tenesmus. Do you think all of this will go away?

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

Yes, it will surely go away if we handle things rightfully. First, we need some testing to confirm what it is. Your symptoms suggest proctitis, but whether it is secondary to infection or due to inflammatory bowel disease, we do not know. The testing I recommended in my last response would answer that question. I will list the investigations below.

Secondly, I suggest you start a course of Ciprofloxacin and Metronidazole antibiotics for at least five days. If you have completed the course, then proceed with the testing, and we will decide further. If you have not taken these medications for five days before, I recommend you start them right away. Additionally, take Isabgol husk two tablespoons daily. You can continue Mebeverine for now.

Naringenin (NGN) cream would not improve tenesmus. It basically improves the spasm of the muscles of the anal canal and would alleviate the pain associated with anal fissures. An anal fissure causes a sore anal area and burning/pain while or after defecation.

Tenesmus, on the other hand, is a symptom of rectum inflammation, which means a repetitive, painful urge to pass stools that often fails to pass stools. This is a symptom of rectal inflammation, and the only thing that can improve this is proper treatment of rectum inflammation. If you do not have pain in the anal area and only experience urgency and tenesmus, you can stop using NGN and any other local treatments. Since the nozzle or finger used for application would irritate the rectum more.

Thank you.

Patient's Query

Thank you, doctor, for the reply,

I am currently on Ciprofloxacin but not Metronidazole. I will take the tests when I am off work. Additionally, there are some symptoms that I have noticed: I have weak ejaculation. I can achieve a normal erection, but the ejaculation is weak. Also, when dealing with tenesmus, I performed some pelvic muscle exercises, and the tenesmus improved and eventually went away. This makes me wonder if it is a muscle disorder resulting from sitting on hard surfaces. I spent months sitting on a bad chair, which caused issues with my tailbone and also sat on concrete for lunch for months. I do wonder if that is the cause.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

Please add Metronidazole 400 mg thrice daily to your existing regimen. I do not think sitting on a bad chair or hard surfaces has led you to develop tenesmus. The cause of tenesmus is within the rectum. Since you have recently experienced this problem, the possibility of acute inflammation in the form of infection is highly likely. The chances of a condition like solitary rectal ulcer syndrome (SRUS), which is a condition of ulcer formation within the rectum due to chronic constipation and straining during bowel movements (dyssynergia), are less likely. SRUS can also cause tenesmus.

So, to simplify, it is basically rectal inflammation that is the reason behind tenesmus, and I believe it is acute and not chronic. Doing pelvic exercises is otherwise good. It is excellent for those who have chronic constipation secondary to dyssynergia. However, since we have not yet made the diagnosis of dyssynergia, I think it is premature to recommend it to you at the moment. Dyssynergia is diagnosed via anal rectal manometry. Regarding ejaculation, since I am not an expert in this problem, I suggest that you seek help from a urologist if you think it is necessary.

If you want, you can consult me via a video consultation, as we can discuss in more detail and address your concerns more easily.

Thank you.

Patient's Query

Thank you, doctor, for the reply,

I am starting to feel better, but it seems that at night after work when I lay down on my back in bed, that is when I feel tenesmus or pressure in my rectum. However, if I lie on my side, the pressure goes away, as if the issue is on the back surface of my rectum. Does this change your differentials?

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

Well, that pressure is not tenesmus, actually. By definition, tenesmus is a failed painful urge to defecate. The pressure you feel while lying supine on the bed could be coming from the coccyx - the tailbone. Since I recall you have had problems with your tailbone due to sitting on hard surfaces and a bad chair before, this seems to be the reason for your current symptom. If you feel a repetitive urge to pass stools with mucus, then as suggested before, take a repeat course of Ciprofloxacin and Metronidazole for five days.

For the tailbone problem, I suggest getting physically checked by a general practitioner and applying some pain-reducing cream such as pain reliever gel thrice daily until the pain subsides. Also, use soft surfaces for sitting and sleeping. Since it all started with some changes in bowel habits and with pain in the anus, this could be due to inflammation in the rectum. However, it is wise to physically get checked for coccyx tailbone tenderness. You can also apply some gentle pressure over the tailbone yourself and see if it causes tenderness.

Thank you.

Patient's Query

Thank you, doctor, for the reply,

So overall, things have progressed for the better. I got my blood work done, which was unremarkable. I have a sigmoidoscopy scheduled for next month. My stool is nicely formed and normal. However, I still deal with rectal tension, feeling like I am constantly contracting my anus when walking. I keep clenching and letting go, and it is voluntary. I think anxiety might be the cause of this tension, but I am not certain. During some investigation, I felt a small pea-sized lump on the anterior of my anal canal, maybe an inch within the rectum. This lump is freely movable and a bit squishy as if I can pop it, but there is some discomfort if I try to squeeze it. What could this thing be, and could it be cancerous? I do not have any other symptoms other than the tension and the lump I felt.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

I am glad to hear you are doing well. This voluntary squeezing of the anal canal can be either painful or not painful. If it is painful, it is called proctalgia. Regardless, of whether voluntary or involuntary, this movement can be minimized by behavioral changes. Try to ignore it and remove any anxiety that may be contributing to the belief that you are physically ill. How is your sleep? Do you experience obvious anxiety or panic episodes that you feel need to be treated? Because some level of anxiety is common in individuals our age, and it can often be without reason. This anxiety is usually not sustained and can spontaneously go away within days. However, if you are interested, I can suggest some anxiolytic medications.

Regarding the lump, it could be a chronic anal fissure, as we discussed earlier in our conversation. They may cause pain initially, but with medications and good fiber intake, the pain usually subsides, leaving behind a small scar. Alternatively, it could be a simple anal tag, which appears as a dark brown to black fleshy outgrowth, movable, and almost always not painful. The sigmoidoscopy would help us establish these possibilities with more confidence. I look forward to seeing your report.

Thank you.

Patient's Query

Thank you, doctor, for the reply,

The lump is inside the anus and not on the outside. I have to insert my finger halfway to feel it on the anterior surface. I remember you mentioning that a painless nodule could be SCC. What do you think?

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

That thing will be well observed during sigmoidoscopy. I do not think it is wise to make assumptions or give straightforward diagnoses based on feeling a vague lump. Both the anal canal and rectum are lined by a surface epithelial layer. Since it is inside the lumen, which you cannot see with the eye but can only feel, it might just be the epithelial lining (mucosa) and not a serious issue. I mean, this could be a completely normal occurrence and not cancerous at all. Anal tags can arise within the anal canal epithelial lining and may only be palpable outside the anal canal. In fact, we often see these anal tags deep-seated in the anal canal lumen during digital rectal examinations.

At the moment, since it is not bleeding or causing pain, it suggests that things have probably healed from before. The best course of action I can suggest is to wait for the sigmoidoscopy, which will provide clearer information for deciding on future treatment if required.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Ajeet Kumar
Dr. Ajeet Kumar

Medical Gastroenterology

Community Banner Mobile
By subscribing, I agree to iCliniq's Terms & Privacy Policy.

Ask your health query to a doctor online

Medical Gastroenterology

*guaranteed answer within 4 hours

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.

This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy