Anal fissure
An anal fissure is a small crack in the mucous membrane of the anal canal. Although it may be a relatively minor damage, a fissure can cause a striking amount of pain. Especially during and after the stool the pain can be sharp, cutting or burning. Sometimes some bright red blood is visible on the toilet paper or on the outside of the stools.
A fissure often occurs after hard or dry stools and presses during constipation. The tear can then reopen with each bowel movement, making it more difficult to heal and chronic.
Acupuncture and Chinese herbal medicine can be used in addition. In addition, it is important to look not only at the fissure itself, but especially at factors that hinder recovery, such as constipation, dry stools or reduced local blood flow.
Common symptoms
An anal fissure can cause, among other things, the following complaints:
- sharp, cutting or burning pain during the stool;
- pain that may persist for some time after stool;
- clear red blood on the toilet paper or on the outside of the stool;
- hard or dry stools and constipation;
- fear of stool due to pain;
- long-term or recurring symptoms in chronic fissure.
Not every fissure gives the same symptoms. The severity depends, among other things, on the depth of the tear, the stool and how long the fissure has been present.
Possible causes
The most common cause is hard, dry stools that damage the mucous membrane during bowel movement. Chronic constipation and regular pressing increase the risk.
Once a fissure is formed, a vicious circle can occur. The feces pull the wound open again, while pain can lead to increased tension of the anal circular muscle. This can reduce local blood flow and delay recovery.
Less often a fissure occurs due to local injury. In the case of recurrent, multiple or unusually located fissures there may be an underlying condition and further medical examination is important.
What can acupuncture do?
The treatment will focus on factors that cause the fissure to get irritated again and again or insufficiently repaired. An important goal is therefore to support a regular bowel movement with soft stools.
Within Chinese medicine, attention can also be paid to Heat, dryness or stagnation of Qi and Blood. In the case of long-term complaints, a shortage of Blood and Yin can play a role, which is why TCM does not provide sufficient moistening of the intestines.
Possible treatment principles include:
- Controlling bowel function and stool
- Reduce dryness and soften stool
- Reduce pain and local tension
- Improve Qi and Blood flow
- Reduce heat when there is obvious burning or inflammatory symptoms
- Supporting Blood and Yin in chronic dryness
What can Chinese herbal medicine do?
Chinese herbs can be used additionally when constipation, dry stools or other underlying patterns complicate the recovery of fissure.
For example, in the case of hard and dry stools, treatment can be aimed at moistening the Large Intestin and facilitating bowel movement. In clear Heat, other herbs are chosen than when the dryness is related to a shortage of Blood or Yin. In the case of a prolonged, difficult healing fissure, improving blood flow may become more important.
Possible treatment principles include:
- Wet the Large Intestine
- Keep the stool soft and regular
- Reduce heat
- Blood and Yin feeding in chronic dryness
- Improve the circulation of Qi and Blood
- Supporting the recovery of damaged tissue
The herbal treatment is always tailored to the overall symptoms. For example, the use of highly laxative herbs is not automatically suitable for any form of constipation.
How does Chinese medicine view an anal fissure?
Within Western medicine, attention is focused on the damage to the mucous membrane, the consistency of the feces and factors such as increased tension of the anal circular muscle.
In addition, the traditional Chinese Medicine (TCM) looks at the underlying imbalance that causes or makes it difficult to heal.
The Large Intestine plays an important role in this. If too much heat is present according to TCM, body fluids can dry out, making the stool hard. If there is a shortage of Blood or Yin, it can also cause insufficient moisturisation. If there is a prolonged fissure, Blood stasis can also occur. This means that the local blood flow is inadequate, causing pain and slower recovery.
A TCM organ system is not the same as the anatomical organ from Western medicine. It describes a broader set of bodily functions.
A recognizable combination of signs and symptoms is called a TCM pattern within Chinese medicine.
Read more at TCM basics Organ Systems .
Read more at TCM basics • TCM patterns .
Only the most common patterns in an anal fissure are described below. Other patterns are possible and multiple patterns may occur at the same time. You do not need to have all of these symptoms to fall within a particular pattern. The pattern is determined by the overall picture of complaints.
Most common TCM patterns
Heat
In this pattern, Heat dries out the liquids in the Large Intestine according to TCM. As a result, the stool becomes hard and dry and can damage the mucous membrane during the bowel movement or re-open an existing fissure.
Common symptoms: sharp or burning anal pain that gets worse during the stool, hard and dry stools, constipation and bright red blood. The fissure can be red and easily bleed. In addition, thirst, dry mouth and feeling full or tense in the abdomen may occur.
Examples of Western disorders: acute anal fissure and constipation with hard, dry stools.
Soft and regular stool retention is an important part of the treatment in this pattern.
Blood- and Yin-deficiency
According to TCM, there is insufficient nutrition and humidification of the Large Intestine. This can cause chronic dry stools and makes the mucous membrane more vulnerable. This pattern occurs especially in the case of long-term or recurring complaints.
Common symptoms: pain during the stool, chronic constipation with dry, hard or choppy stools and small amounts of bright red blood. In addition, dry skin, dry eyes, mouth or throat, fatigue, dizziness, blurred vision, palpitations or sleep problems can occur.
Examples of Western disorders: chronic anal fissure and chronic constipation with dry stools.
In this pattern, the emphasis is not only on stimulating bowel movement, but above all on improving intestinal moisturization for a longer time.
Blood stasis
According to TCM Blood stasis occurs when the local blood flow is blocked for a long time. In a fissure, this is seen especially when the complaint has become chronic and the damaged tissue is difficult to heal.
Common symptoms: a prolonged, clearly painful fissure with persistent or sharp pain. The fissure can be dark red or purple-like and have thickened or hard edges. Constipation and hard stools may exacerbate the pain and bright red or darker blood may occur.
Examples of Western diseases: chronic anal fissure and a difficult healing fissure with scarring.
A chronic fissure that despite measures to keep the stool soft does not heal, may need regular treatment.
What can you do for yourself?
An important part of the recovery is to prevent the fissure from being damaged again during each bowel movement. Therefore, try to keep the stool soft and regular by drinking enough and eating high-fiber. Avoid prolonged pressing and adjusting the stools unnecessarily.
The area can be gently cleaned with lukewarm water after bowel movement. Avoid rubbing hard, perfumed products and other substances that may irritate the skin. A warm sitting bath can help some people temporarily reduce pain and tension around the anus.
Outlook
An acute fissure can often heal when the stool is consistently kept soft and repeated damage is prevented. In chronic fissures recovery may take more time, especially if constipation persists or local muscle tension and blood flow hinder recovery.
In addition to acupuncture or herbal treatment, the course of treatment depends on the duration of the complaint, the severity of the fissure, the stool pattern and the underlying TCM pattern. In the initial phase, for example, it can be treated once a week, after which the frequency can be reduced if improved. This is a guideline and is adjusted individually.
When to contact a doctor?
Let persistent or recurrent anal pain and blood loss be assessed, especially if it has not been previously established that it is a fissure. Blood loss from the anus can also have other causes.
Medical assessment is particularly important in case of high or persistent blood loss, fever, pus, increased swelling or severe pain, a fissure that does not heal or returns regularly, or changes in stool pattern which cannot be explained properly.
Contact
Do you suffer from anal fissure and do you want to know whether acupuncture or Chinese herbal medicine can mean anything for your complaints? Please feel free to contact us. During the intake, you will look at the fissure, your stool and any other complaints to adjust the treatment to the overall image.