What should I do if I have rectal bleeding due to anal fissure?

Nov 15, 2025 Source: Cainiu Health

Dr. Li Jingxiang

Introduction

In general, treatment methods for bleeding due to anal fissures in stool include conservative management, topical medication, oral drug therapy, traditional Chinese medicine, and surgical treatment. The key to treating anal fissures lies in preventing recurrence; patients need to maintain healthy eating habits and bowel routines long-term. If symptoms such as increased bleeding, worsening pain, or fever occur during treatment, medical attention should be sought promptly.

In general, treatment methods for anal fissures with bleeding include conservative management, topical medication, oral drug therapy, traditional Chinese medicine (TCM), and surgical intervention. Specific analyses are as follows:

1. Conservative Management

Maintain cleanliness and dryness of the perianal area. Gently wash with warm water after each bowel movement, avoiding vigorous wiping that may worsen the tear. Adjust diet by consuming more fiber-rich foods such as bananas and dragon fruit, and drink plenty of water to soften stools and prevent constipation, which can lead to recurrent anal fissures. Establish regular bowel habits, avoid prolonged squatting or sitting on the toilet, and reduce pressure on the anal region.

2. Topical Medication

Topical treatments act directly on the fissure to promote healing and relieve pain. Patients may use medications such as glyceryl trinitrate ointment, compound algininate cream, or recombinant human epidermal growth factor gel under medical guidance. Ensure the perianal area is clean before application to prevent infection.

3. Oral Drug Therapy

For anal fissures caused by constipation, oral medications are used to improve bowel movements. Under medical supervision, patients may take lactulose oral solution, polyethylene glycol 4000 powder, or wheat bran fiber granules to soften stools, reduce irritation to the fissure during defecation, and create favorable conditions for healing.

4. Traditional Chinese Medicine (TCM)

TCM attributes anal fissures primarily to internal heat, intestinal dryness, yin deficiency, and insufficient body fluids. Treatment focuses on clearing heat, moistening dryness, cooling blood, and stopping bleeding. Under medical advice, patients may take proprietary Chinese medicines such as Huaijiao Pills, Maziren Runchang Pills, or Zhisuning Tablets. Acupuncture may also be used to stimulate perianal acupoints, improve local blood circulation, and alleviate pain.

5. Surgical Treatment

Surgery may be required when chronic anal fissures recur repeatedly, develop into long-standing ulcers, or are accompanied by sentinel piles or hypertrophied anal papillae, especially if conservative treatments are ineffective. The most common procedure is fissurectomy—removal of the diseased tissue to allow fresh wound healing. Strict postoperative perianal care is essential to prevent infection.

The key to treating anal fissures lies in preventing recurrence. Patients should maintain healthy dietary and bowel habits over the long term. If symptoms such as increased bleeding, worsening pain, or fever occur during treatment, discontinue medication and seek immediate medical attention. Regular follow-up visits after surgery and adherence to medical advice during recovery help minimize the risk of recurrence.

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