Anal Fissures and Hemorrhoids in Crohn’s Disease

Written by Hallie Levine

• What Are Anal Fissures and Hemorrhoids?
• Why Do You Get Anal Fissures and Hemorrhoids With Crohn’s Disease?
• What Are the Symptoms of Anal Fissures and Hemorrhoids?
• How Are Anal Fissures and Hemorrhoids Diagnosed?
• How Are Anal Fissures and Hemorrhoids Treated?
• How Do You Prevent Anal Fissures and Hemorrhoids?
• More

If you have Crohn’s disease, you know that day-to-day life can be challenging. But besides the condition itself, there are other complications that can literally be a pain in the butt. These are hemorrhoids and anal fissures, two conditions that can crop up with Crohn’s disease.

Anal fissures are small tears or sores in your butt lining. They may cause sharp pain and bleeding when you poop. They are fairly common with Crohn’s disease and can be there even before any other symptoms of Crohn’s pop up.

Hemorrhoids are swellings around your butt that contain enlarged blood vessels. You may have itching, soreness, or swelling, and you may also notice pain and blood when you poop.

Usually, you get anal fissures because you’re constipated: When you’re plugged up, a particularly large or hard BM can tear the lining of your butt canal. It can also be caused by too-tight anal sphincters (the rings of muscles at the opening of your butt). But with Crohn’s disease, there are some key differences:

• Your anal fissures are most likely due to the chronic inflammation of the lining of your GI tract.
• You’re likely to have several anal fissures, rather than just one.
• Your fissures usually run down the sides of your butt, rather than the middle.
• You may also have skin tags in your butt canal that can be mistaken for hemorrhoids.

Hemorrhoids aren’t as common as fissures if you have Crohn’s disease. If you do develop hemorrhoids, it’s thought that they’re due not to the inflammation associated with Crohn’s, but to diarrhea or constipation related to it, which can put extra pressure on butt veins.

Sometimes, you can have anal fissures and feel totally fine. But symptoms usually include:

• Bleeding
• Deep ulcers
• Butt pain, which is present at rest but gets worse during a bowel movement

About 40% of people with hemorrhoids don’t have any symptoms at all. But if you do have them, they include:

• Bright red blood when you poop. It may coat your bowel movement or drip into the toilet.
• Mild fecal incontinence, or trouble holding in poop
• Mucus, wetness, or a feeling of fullness in your butt area
• Irritation or itching of the skin in your butt crack

Anal fissures are often confused with hemorrhoids. The big difference is that while hemorrhoids may cause some mild discomfort, they really don’t hurt.

Your doctor will diagnose both fissures and hemorrhoids with a physical exam. (It might be a little awkward and embarrassing, since they may have you bend over and spread your butt cheeks so they can take a closer look. )

If a fissure is relatively new, it will look like a paper cut. If it’s been there a long time, it’ll have raised edges that expose the fibers of your internal anal sphincter muscles at its base. It often comes with skin tags that can be misdiagnosed as hemorrhoids.

Your doctor will make a diagnosis of hemorrhoids based on your medical history and a physical exam, which includes:

• A visual check of the area around your butt
• A digital rectal exam to check your butt’s muscle tone, and to see if you have internal hemorrhoids
• An anoscopy or proctosigmoidoscopy. In these procedures, your doctor uses devices to view the lining of your butt for internal hemorrhoids. They can be done during an office visit without anesthesia.

If you have Crohn’s disease, anal fissures are treated pretty much the same way as they are with people who don’t have the condition. This includes:

• Warm sitz baths. Soak in warm water for 10 to 20 minutes several times a day, especially after you have a bowel movement.
• Topical anesthetic creams like lidocaine to relieve pain
• Topical nifedipine or nitroglycerin. These prescription creams ease pressure of your butt muscles to lessen pain and encourage healing. You’ll apply a pea-sized dot around your butt opening twice a day. It can cause side effects like a mild headache and low blood pressure. You can’t take it at the same time that you use other medicines to treat erectile dysfunction, like sildenafil (Viagra).

If your anal fissure doesn’t respond to these treatments, it may be because of active inflammation from your Crohn’s disease. Your doctor will work with you to get it under control with medical therapy. While there is surgery to relax the anal sphincter muscles, it isn’t recommended in patients with Crohn’s disease. Since their fissures aren’t related to tight anal sphincter muscles, it won’t help and may trigger fecal incontinence (pooping in your pants).

If you have Crohn’s disease and get hemorrhoids, your doctor will at first treat you the same way they treat other patients. This may include:

A high-fiber diet. Your doctor will want you to eat 20 to 35 grams a day of foods such as fruits and vegetables. You can also try a fiber supplement, such as psyllium, methylcellulose, polycarbophil, and wheat dextrin.

Warm baths. Sit in 2 to 3 inches of warm water and soak your butt for 10 to 15 minutes, two to three times daily. This improves blood flow and relaxes your anal sphincter muscles. Don’t add soap, bubble bath, or other things.

Oral phlebotonics. These are a class of drugs that contain plant extracts such as flavonoids. They appear to reduce some of the bleeding that comes with hemorrhoids. One review of 24 clinical trials found that phlebotonics significantly improved symptoms such as itching and bleeding.

Although surgery’s often used to treat hemorrhoids, it’s not recommended for patients with Crohn’s disease. It’s been linked to major complications like sepsis, fistulas, fecal incontinence, and wounds that don’t heal.

You can help reduce your chances of having both by making sure your Crohn’s disease is under control, and also reducing constipation. Eat more high-fiber foods such as fruits, vegetables, and whole grains, and drink 6 to 8 glasses of water a day.

Top Picks

Anal Fissures and Hemorrhoids in Crohn’s Disease

Written by Hallie Levine

• What Are Anal Fissures and Hemorrhoids?
• Why Do You Get Anal Fissures and Hemorrhoids With Crohn’s Disease?
• What Are the Symptoms of Anal Fissures and Hemorrhoids?
• How Are Anal Fissures and Hemorrhoids Diagnosed?
• How Are Anal Fissures and Hemorrhoids Treated?
• How Do You Prevent Anal Fissures and Hemorrhoids?
• More

If you have Crohn’s disease, you know that day-to-day life can be challenging. But besides the condition itself, there are other complications that can literally be a pain in the butt. These are hemorrhoids and anal fissures, two conditions that can crop up with Crohn’s disease.

Anal fissures are small tears or sores in your butt lining. They may cause sharp pain and bleeding when you poop. They are fairly common with Crohn’s disease and can be there even before any other symptoms of Crohn’s pop up.

Hemorrhoids are swellings around your butt that contain enlarged blood vessels. You may have itching, soreness, or swelling, and you may also notice pain and blood when you poop.

Usually, you get anal fissures because you’re constipated: When you’re plugged up, a particularly large or hard BM can tear the lining of your butt canal. It can also be caused by too-tight anal sphincters (the rings of muscles at the opening of your butt). But with Crohn’s disease, there are some key differences:

• Your anal fissures are most likely due to the chronic inflammation of the lining of your GI tract.
• You’re likely to have several anal fissures, rather than just one.
• Your fissures usually run down the sides of your butt, rather than the middle.
• You may also have skin tags in your butt canal that can be mistaken for hemorrhoids.

Hemorrhoids aren’t as common as fissures if you have Crohn’s disease. If you do develop hemorrhoids, it’s thought that they’re due not to the inflammation associated with Crohn’s, but to diarrhea or constipation related to it, which can put extra pressure on butt veins.

Sometimes, you can have anal fissures and feel totally fine. But symptoms usually include:

• Bleeding
• Deep ulcers
• Butt pain, which is present at rest but gets worse during a bowel movement

About 40% of people with hemorrhoids don’t have any symptoms at all. But if you do have them, they include:

• Bright red blood when you poop. It may coat your bowel movement or drip into the toilet.
• Mild fecal incontinence, or trouble holding in poop
• Mucus, wetness, or a feeling of fullness in your butt area
• Irritation or itching of the skin in your butt crack

Anal fissures are often confused with hemorrhoids. The big difference is that while hemorrhoids may cause some mild discomfort, they really don’t hurt.

Your doctor will diagnose both fissures and hemorrhoids with a physical exam. (It might be a little awkward and embarrassing, since they may have you bend over and spread your butt cheeks so they can take a closer look.)

If a fissure is relatively new, it will look like a paper cut. If it’s been there a long time, it’ll have raised edges that expose the fibers of your internal anal sphincter muscles at its base. It often comes with skin tags that can be misdiagnosed as hemorrhoids.

Your doctor will make a diagnosis of hemorrhoids based on your medical history and a physical exam, which includes:

• A visual check of the area around your butt
• A digital rectal exam to check your butt’s muscle tone, and to see if you have internal hemorrhoids
• An anoscopy or proctosigmoidoscopy. In these procedures, your doctor uses devices to view the lining of your butt for internal hemorrhoids. They can be done during an office visit without anesthesia.

If you have Crohn’s disease, anal fissures are treated pretty much the same way as they are with people who don’t have the condition. This includes:

• Warm sitz baths. Soak in warm water for 10 to 20 minutes several times a day, especially after you have a bowel movement.
• Topical anesthetic creams like lidocaine to relieve pain
• Topical nifedipine or nitroglycerin. These prescription creams ease pressure of your butt muscles to lessen pain and encourage healing. You’ll apply a pea-sized dot around your butt opening twice a day. It can cause side effects like a mild headache and low blood pressure. You can’t take it at the same time that you use other medicines to treat erectile dysfunction, like sildenafil (Viagra).

If your anal fissure doesn’t respond to these treatments, it may be because of active inflammation from your Crohn’s disease. Your doctor will work with you to get it under control with medical therapy. While there is surgery to relax the anal sphincter muscles, it isn’t recommended in patients with Crohn’s disease. Since their fissures aren’t related to tight anal sphincter muscles, it won’t help and may trigger fecal incontinence (pooping in your pants).

If you have Crohn’s disease and get hemorrhoids, your doctor will at first treat you the same way they treat other patients. This may include:

A high-fiber diet. Your doctor will want you to eat 20 to 35 grams a day of foods such as fruits and vegetables. You can also try a fiber supplement, such as psyllium, methylcellulose, polycarbophil, and wheat dextrin.

Warm baths. Sit in 2 to 3 inches of warm water and soak your butt for 10 to 15 minutes, two to three times daily. This improves blood flow and relaxes your anal sphincter muscles. Don’t add soap, bubble bath, or other things.

Oral phlebotonics. These are a class of drugs that contain plant extracts such as flavonoids. They appear to reduce some of the bleeding that comes with hemorrhoids. One review of 24 clinical trials found that phlebotonics significantly improved symptoms such as itching and bleeding.

Although surgery’s often used to treat hemorrhoids, it’s not recommended for patients with Crohn’s disease. It’s been linked to major complications like sepsis, fistulas, fecal incontinence, and wounds that don’t heal.

You can help reduce your chances of having both by making sure your Crohn’s disease is under control, and also reducing constipation. Eat more high-fiber foods such as fruits, vegetables, and whole grains, and drink 6 to 8 glasses of water a day.

Top Picks

Complications of Crohn’s disease – Health Clinic 365 Ekaterinburg

Crohn’s disease, symptoms

Causes of Crohn’s disease

Crohn’s disease. Questions for a Doctor

Diagnosis of Crohn’s Disease

Treatment of Crohn’s Disease

Crohn’s disease can lead to one or more of the following complications :

Intestinal obstruction. Crohn’s disease affects the entire thickness of the intestinal wall. Over time, some sections of the intestinal wall may thicken, and the intestinal lumen may narrow. This can impede the passage of food, and even lead to obstruction. In some cases, surgery is required to remove the affected parts of the intestine.

Ulcers. Chronic inflammation can lead to ulcers anywhere in the digestive tract, including the mouth, genital area (perineum), and anus (anus).

Fistulas. Sometimes ulcers can spread in depth to the entire thickness of the intestinal wall, forming a pathological hole in the intestinal wall and creating a fistula. A fistula is an abnormal communication between different parts of your intestines, between your intestines and skin, or between your intestines and another organ, such as your bladder or vagina. When internal fistulas (between internal organs) occur, food may not reach the areas of the intestine that are needed for absorption. An external fistula (between the intestines and the skin) can cause continuous drainage of intestinal contents through a hole in the skin, and in some cases, the fistula can become infected with microorganisms and lead to an abscess, a problem that can be life-threatening if left untreated.

Anal fissure. These are cracks in the anus or skin around. An anal fissure is often accompanied by a secondary infection, which usually causes pain during stool passage.

Nutrient malabsorption. Nutrient malabsorption often leads to anemia. This is due to the fact that the affected intestine, in Crohn’s disease, is not able to absorb enough nutrients. In addition, frequent loose stools, abdominal pain and intestinal cramps lead to loss of appetite, thereby reducing the amount of nutrients consumed.

Other health problems. In addition to inflammation and ulcers in the gastrointestinal tract, Crohn’s disease can lead to problems in other organs, such as arthritis (inflammation of the joints), damage to the eyes or skin, nail changes, kidney and gallstones, and sometimes and inflammation of the bile ducts. People with long-term Crohn’s disease often have osteoporosis, which causes bones to become more fragile.

Inflammatory bowel disease and colon cancer.

Having Crohn’s disease increases the risk of colon cancer. Despite this increased risk, more than 90 percent of people with inflammatory bowel disease will never develop cancer.
Your risk of getting cancer is significantly higher if you have had inflammatory bowel disease for at least eight years and if the disease has spread throughout your colon. The longer the course of the disease and the larger the affected area, the higher the risk of colon cancer. The risk of other types of cancer is also increased, including anal cancer.

Crohn’s disease: symptoms, diagnosis and treatment.

Chronic disease of the gastrointestinal tract, prone to recurrence and the development of local and systemic complications, is called Crohn’s disease.

Currently, there is still no unambiguous answer to the question about the causes of this pathology. There are opinions about the viral nature of Crohn’s disease , a genetic predisposition to a decrease in local intestinal immunity.

In our medical center, all types of treatment for intestinal diseases are as effective and painless as possible.

The disease is dangerous with complications:

• fistulas,
• anal fissures,
• abdominal abscesses,
• intestinal bleeding.

Abdominal pain may be indicative of appendicitis or bowel obstruction.

It is known that Crohn’s disease can be accompanied by damage to almost any part of the digestive tract, but the large intestine is most often affected.

Crohn’s disease: symptoms and features

In some cases, the disease in the early stages goes unnoticed and the patient does not immediately notice the first symptoms. But in some patients, Crohn’s disease can immediately manifest as pain, heaviness in the abdomen, and slight discomfort.

Diarrhea occurs up to about five times a day, while the feces are mushy.

In the first stage of the development of Crohn’s disease, other symptoms may also occur: paraproctitis, anal fissures or fistulas, their course is inactive, and the regeneration process is slower.

Crohn’s disease can present with both general and local symptoms. Patients complain of pain in the abdomen, loose stools, bleeding from the anus.

Quite often, in Crohn’s disease, there is such a symptom as intestinal obstruction, which requires immediate intervention by specialists.

Fever, fever and general weakness are clear signs that a patient has Crohn’s disease. Symptoms may also manifest as weight loss.

Insufficient intake of nutrients in the body, which is observed with intestinal damage in Crohn’s disease, is accompanied by anemia, hypovitaminosis and mineral deficiency. Many patients develop malabsorption syndrome and gallstone formation.

Diagnosis is made to detect Crohn’s disease

Diagnosis is established by comparing clinical and pathomorphological features (irrigoscopy and endoscopy).

Endoscopic, X-ray and morphological examinations are performed to accurately diagnose the disease. To identify Crohn’s disease, diagnosis is based on the study of anal lesions, radiological and endoscopic symptoms.

After the diagnosis of Crohn’s disease, treatment is prescribed

Our specialists will select an individual treatment plan for you, conduct a full range of therapy, and monitor your recovery process. Depending on the stage and localization of the pathological process, the presence of complications of Crohn’s disease, the direction of treatment is established.

Sometimes haemostatic agents are sufficient. But in more complex forms of Crohn’s disease,

• hemosorption,
• ultraviolet irradiation,
• plasma sorption.

Intestinal obstruction, which can also be caused by Crohn’s disease, is treated with surgery.

It is important that you contact us in time. Our specialists will help to avoid possible complications that are caused by Crohn’s disease.