Seeing blood on toilet paper or on the stool is a frightening experience for everyone. When most of my patients experience this, their first reaction is to say, “I have hemorrhoids,” and buy random creams from the pharmacy. However, hemorrhoids are not the only cause of bleeding.
Sometimes, this bleeding is accompanied by a sharp pain during defecation—as if “passing shards of glass”—followed by an ache that lasts for hours. This clinical picture is usually the herald of an Anal Fissure.
So, why does this tear occur, does an anal fissure heal on its own, and when is bleeding a sign of a serious disease (such as cancer)? As a General Surgery Specialist, I would like to clarify this vital distinction.
Anal Fissure: Beware of the Vicious Cycle
An anal fissure is a tear in the sensitive skin tissue at the exit of the anus, usually occurring after a hard bowel movement or a bout of diarrhea.
Although this tear appears small, the pain it creates is significant. This is because when the tear occurs, the anal muscles (sphincters) contract due to pain (spasm). This contraction impairs blood flow; when blood flow is impaired, the wound does not heal. When the wound doesn’t heal, the pain continues, creating a “vicious cycle.”
Does an Anal Fissure Heal on Its Own?
The answer to the frequently asked question, “Does an anal fissure heal on its own?” depends on whether the fissure is “Acute” or “Chronic.”
- Acute Fissure (New Onset): If the tear is superficial and the constipation problem is resolved immediately, it can heal within 1-2 weeks with warm water sitz baths and creams.
- Chronic Fissure (Non-healing): If your complaints persist for longer than 6-8 weeks, the edges of the wound have hardened, and a “sentinel tag” (skin tag) has formed at the anal entrance, this fissure will not heal on its own.
- At this stage, to resolve the muscle spasm and reduce pain, we first recommend diet, anal muscle relaxant medications, warm water sitz baths, and mineral/vitamin supplements tailored to the patient. For chronic fissures where these treatments do not work, we recommend surgery using techniques appropriate for the physiology of the anus.
When Does Rectal Bleeding Become Dangerous?
Now, to the most important issue: Bleeding. Not all rectal bleeding is innocent. Especially in individuals over the age of 40 or those with a family history of cancer, the situation must be taken seriously.
When is rectal bleeding dangerous? Here are the alarm bells:
- Color of the Blood: Bright red blood usually indicates hemorrhoids or a fissure. However, dark red, maroon, or black (tar-like) stools indicate serious bleeding coming from further up (intestines or stomach).
- Stool Shape: Narrowing of the stool (coming out like a pencil) may indicate that a mass (tumor) in the intestine is narrowing the path.
- Accompanying Symptoms: Do not lose time if bleeding is accompanied by unexplained weight loss, loss of appetite, abdominal pain, or a change in bowel habits (alternating diarrhea and constipation).
- Clotting: If blood comes in the form of clots, the amount of bleeding is high and can lead to anemia.
Conclusion: Early Diagnosis Saves Lives
“I couldn’t go to the doctor because I was embarrassed” is, unfortunately, one of the sentences I hear most often and feel the most saddened by. Diseases of the anal region are biological and natural, just like eye or heart diseases.
If you have a non-healing anal fissure or bleeding of unknown cause, instead of wasting time with creams found on the internet, you should be examined by a proctology specialist. Sometimes, a condition you think is a simple fissure could be a harbinger of rectal cancer, or conversely, a condition you fear is cancer can be resolved with a simple fissure treatment.
Do not leave your health to chance or time.
Assoc. Prof. Dr. Yahya Çelik General Surgery Specialist & Proctology
