Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
|shortmama11 - Sun Jul 25, 2010 2:08 pm||
I had a colonoscopy done in 2008 for bleeding with bowel movements. I do not have hemorrhoids. I have a history of anal fissures. Sometimes when I have a bowel movement, it feels like glass coming out. It is very, very painful. It feels as if my colon/rectum/anus are not large enough to accomodate my waste. The colonoscopy did not reveal anything that would cause this. I have had this problem on and off for the past 12-13 years. I am now 24 years of age. I have bouts of constipation and bouts of diarrhea, also symptoms that come and go. I bleed with the bowel movement and sometimes enough that it turns the toilet water red. Do you have an idea of what this might be? I just want to fix it or at least control the symptoms.
|Dr.M.Aroon kamath - Tue Jul 27, 2010 11:35 am||
your history suggests an anal fissure. Anal fissure may be acute or chronic.
Anal fissure is basically a slit in the anal skin(the anoderm).
An acute anal fissure is usually caused by passage of hard stool which tears the anoderm at the 6 o'clock position(in the lithotomy position).In children (and in some adults as well), it may be caused by a bout of diarrhea or dysentery. Fissures can also be caused by,anal intercourse or foreign body insertion. Pregnancy related fissures also occur and they tend to be in an anterior location.
An acute fissure is very painful, the pain aggravating during defecation. May be associated with bleeding.
A chronic anal fissure on the other hand, is a fissure that is unhealed or tends to remain partially healed.These fissures may be covered by a layer of thin skin and have pearly edges.This thin skin may break down repeatedly causing episodes of acute exacerbation. They may not cause bleeding or may cause a blood streaked stool.
In resistant or recurrent anal fissures, crohn's disease has to be excluded.
It is quit probable that you have a chronic fissure with an acute exacerbation. You need to consult your doctor and get yourself examined. At this stage you may be recommended treatments such as warm sitz baths, topical anesthetic gels, high-fiber diet and stool softeners. Relatively newer treatments include topical nitroglycerin ointment,topical calcium channel blockers,and botulinum toxin.
Some cases which fail to respond may ultimately need surgery(lateral internal sphincterotomy).
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