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What causes blood in stool when diagnosed with anal fissure?

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Posted on Sat, 10 Sep 2016
Question: I recently checked into the hospital because I had some bleeding and pain in the rectal area, and pain in my left side plus lower back pain combined with frequent urination. They gave me a CT scan. Let me give you some background first though. On my regular checkup a year ago they found a trace of blood in my stool so they gave me a colonoscopy. The test came back normal. However in XXXXXXX of this year I noticed a trace of blood on wiping after a BM and went in again. They said it was likely an anal fissure so they gave me a suppository and Proctodan..plus Restorlax to soften the stool. That seemed to work for awhile..A few days ago I woke up to the pain in my side and back and other symptoms I described...Upon having a BM that morning again there was blood on the surface of the stool.. Even more so than what was there in XXXXXXX and increased pain and burning especially when I am walking. The stool has been very thin and soft. I have been treated for the past 20 years or so for chronic prostitus and am now back on antibiotics again....Thats the background...yesterday I got the results of the scan....What it showed was a distended bladder, an enlarged postage and some cloudiness in the rectal area which the family doctor described as possible inflammation. They are now going to refer me to a surgeon but here in Canada it may take awhile to get an appointment...In the meantime I have trouble even sitting down or walking and pain in the anal area. No blood today or yesterday after BM. I would be interested in your thoughts on this and any recommendations you might have concerning both but particularly the pain and occasional bleeding and is it possible for an anal fissure to keep recurring for such a long period of time...Thanks
doctor
Answered by Dr. Rishi (7 hours later)
Brief Answer:
Fissure can recur all your life.

Detailed Answer:
Hello,
Thanks for your question.

It is quite possible for a Fissure in ano to recur and this can happen over many years. Once there is a Fissure it does not really heal completely or very well specially with increasing age, the skin of the anal verge becomes very soft and cracks easily with minor pressure of stools.

Also, the pain would be due to the added component of a possible Urinary tract infection.

Please get a Urine culture done and a Serum PSA done to rule out UTI and any prostatitis, respectively. You could start applying Lignocaine ointment and GTN ointment for the fissure and continue the medicines to keep your stools soft.

Also. you could take Sitz baths to decrease the pain or take pain killers like Tab Paracetamol.

Take care and do let me know if there are other queries on this issue.
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Rishi (1 hour later)
Hi...Thanks for your answer...I did have my urine checked. Showed no infection I assume as they didn't tell me at the hospital..What they said was the prostate was enlarged on the CT scan and the bladder was distended so they gave me antibiotics for prosititus and, Flomax to drain the bladder...The creme they gave me today for the suspected fissure is nifedipine compound.....A question though as this concerns me....Over the years I have had hard stools from time to time..I have been using a rubber glove and been using hydrated body lotion formulated with aloe, on the glove to remove the stools manually.....I have now heard lotions of this type are not for internal use....Am i looking for skeletons or could it be that that usage has caused the problem. Thanks,
doctor
Answered by Dr. Rishi (2 hours later)
Brief Answer:
Constipation needs to be treated.

Detailed Answer:
Hello.
The creme of Nifedipine given to you is fine and similar to the GTN I had advised.
Removal of stools manually is not advised and can cause the fissure to recur.
The problem here is the constipation due to which all this is happening.
I suggest you consult a Gastroenterologist who can help you to resolve the constipation issue and then the fissure would also heal.
Take care and do let me know if I can help further.
Dr Rishi.
Above answer was peer-reviewed by : Dr. Priyanka G Raj
doctor
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Follow up: Dr. Rishi (24 hours later)
my follow-up question is this.....I just had the CT scan 3 days ago which my family doctor said revealed some cloudiness in the anal area,and an enlarged prostate... They have been treating me for the past couple of months for suspected anal fissur and acute non-bacterial postititus as I mentioned in a previous email.Usually it takes weeks up here to see an attending surgeon but they have already scheduled a review with the surgeon in just a few days......What should I read into this.....if anything...Looking for your honest opinion.
doctor
Answered by Dr. Rishi (4 hours later)
Brief Answer:
CT can show prostate but for Fissure you need to get examined.

Detailed Answer:
Hello.
The CT suggestion would be correct. Prostate infection might be there along with a Fissure. But CT is not the best investigation for a Fissure. Clinical examination is the best way to go. It is good that the Surgeon review is soon. Once he examines you everything would be clear. But when you see the Surgeon please mention about your constipation and manual evacuation as well so that he can advice you medicines for that.
That needs to be treated in order for your Fissure to heal.
Do not worry. You would be fine in a few weeks time. But seeing the Surgeon is important.
Take care and feel free to ask any queries as and when they arise.
Dr Rishi.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rishi (31 hours later)
Hi Doc....I have been on Restorlax for 4 days now and taking ultra fibre supplements to soften stools and induce BM's. I am drinking lots of water 4-6 cups per day... Still taking the meds for prostate inflammation(Doxycycline, and Flomax...I have had small bowel movements over the past few days but they are very very strained. The burning sensation I had last week on a BM is no longer there but Still have that dull throbbing pain all the time in the rectal area. I cannot understand why I am still having problems with constipation when I am taking things to assist bowel movements. I don't believe I should really have to strain to induce a BM and I am afraid if I push too hard it will re-open the fissure....Any ideas on this? Thanks
doctor
Answered by Dr. Rishi (12 hours later)
Brief Answer:
It is good that there is no burning now.

Detailed Answer:
Hi.
The constipation is due to a range of factors and age is one of them. As long as there is no pain or burning it is good. Continue the medicines and consult a Gastroenterologist if they can advice something more for the constipation to improve further. As long as you don't have burning you can rest assured that the Fissure is healing. So you don't need to worry about that. And for constipation the best person to advice would be a Gastroenterologist.
Take care and do let me know if I can help you further.
Dr Rishi, XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rishi (38 hours later)
Hi....I have just come from the surgeon....They did notice what they thought was a fissure close to the anal opening so all good there.. Thats what was causing the bleeding from the rectum..However the bit of cloudiness picked up by the CT scan was higher up so they have scheduled a sigmoidoscopy to check the small bowel for hemmoroids, polyps....I had a complete colonoscopy last year and it was clear when it came back......I thought a colonoscopy checked everything.......I have had some problems with constipation in the past ten years off and on... Stool changes and bowel habits have been up and down for me for 25 years....I have not lost any weight at all though, no jaundice, have had some mild abdominal pain(gas, and bloating) mostly last year before the colononoscopy and it still picked up nothing.
So, my question to you is this....What are the chances that I have small bowel cancer now that the CT scan actually picked up? Would like your honest opinion...Thanks
doctor
Answered by Dr. Rishi (12 hours later)
Brief Answer:
It is very unlikely that you have small bowel cancer

Detailed Answer:
Hi.
Your having small bowel cancer is almost impossible. CT had picked up cloudiness much lower down. And cloudiness is not a finding of cancer. Cancer is shown by thickened bowel wall along with lumps or growth with fat stranding and also lymph node enlargement. Secondly small bowel cancer does not lead to constipation. So please don't worry about that. There are no markers to suggest the same.
Do not worry.
Take care and feel free to ask any queries on this issue.
Dr Rishi, XXXXXXX
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Rishi (33 minutes later)
Thanks for your response....here is a followup question based on that....When they took the CT scan I was suffering from chronic non bacterial prostitus, a distended bladder and what they said was an enlarged prostate.. I have had this problem off and on for years, and this time was a very bad episode..My question is this...Could it be possible that the cloudiness picked up in the rectal area was inflammation from the nearby prostate and the prostitus? Also, as my colonoscopy from last year was clear what are the odds that a noticeable polyp in the colon could develop that quickly ...and .Finally, what are the things that could be in the colon that COULD cause some cloudiness on a CT scan Very curious about that.... Thanks
doctor
Answered by Dr. Rishi (6 hours later)
Brief Answer:
It could be due to the prostate.

Detailed Answer:
Hi,
The cloudiness could very well be from the inflamed prostate. That is very much possible.
Secondly, about the Colonoscopy, most likely there would not be any polyp in the Colon, which is a good thing.
Cloudiness on CT Scan is a very vague comment and there would not be much I can comment about it. But if your Colonoscopy is normal you can rest assured that all is well and then you would not need to worry about anything.
Dont stress yourself on these things.
As long as your fissure has healed and if your constipation remains in control then you would be perfectly fine.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Rishi (25 hours later)
I would ask you to explain the wording in laymen's terms from the CT scan if you would.."There is a mild haziness along the left side of the rectal serosa, stranding of the mesorectal fat, nonspecific. No gross evidence of an obstruction rectal lesion, no bowel obstructions. Remainder of colon is unremarkable. Appendix, terminal ileum and small bowel loops are grossly unremarkable."

The urinary bladder is distended with no focal abnormality. Postate gland is enlarged.

Superior segment of the lingula has milds stelectasis" Thanks

I still have not heard from you in regards to the above question...Does stranding of the mesorectal fat(non-specific) on the CT scan mean in most cases there is cancer present? The ct scan made no mention of thickened bowel wall or evidence of growth..so is that good? I am really worried about this and I need your XXXXXXX answer. Thank you in advance
doctor
Answered by Dr. Rishi (34 hours later)
Brief Answer:
Your CT is not suggestive of any cancer.

Detailed Answer:
Hi.
I believe the CT Scan is not suggestive of any cancer. Cloudiness only suggests that the tissue planes are not well characterized in that area. I do not think you should be worried about cancerous growths as there are no such findings on the CT. Stranding of the mesorectal fat means that some inflammation of the rectum has lead to the surrounding fat to get adhered or stuck to the rectal wall.
Atelectasis of lingula means that there is an old disease of the lung which would have caused a small part of the lung to get collapsed.
The finding of normal bowel wall with no growth or obtruction definitely means that you are good and there is almost no chance of you harboring any cancer.
I hope I have answered your questions.
If not then please do let me know.
Take care and hope you feel well
Dr Rishi, XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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What causes blood in stool when diagnosed with anal fissure?

Brief Answer: Fissure can recur all your life. Detailed Answer: Hello, Thanks for your question. It is quite possible for a Fissure in ano to recur and this can happen over many years. Once there is a Fissure it does not really heal completely or very well specially with increasing age, the skin of the anal verge becomes very soft and cracks easily with minor pressure of stools. Also, the pain would be due to the added component of a possible Urinary tract infection. Please get a Urine culture done and a Serum PSA done to rule out UTI and any prostatitis, respectively. You could start applying Lignocaine ointment and GTN ointment for the fissure and continue the medicines to keep your stools soft. Also. you could take Sitz baths to decrease the pain or take pain killers like Tab Paracetamol. Take care and do let me know if there are other queries on this issue. Dr Rishi, New XXXXXXX XXXXXXX