Why is anal sex burning for me?
Anal fissure: Tear in the anal mucosa, which is usually harmless, but causes severe pain when defecating. The anal fissure is one of the most common diseases of the anus and affects men and women equally. Causes are injuries to the sensitive anal mucosa, e.g. B. hard stool or sexual practices. With ointments, Sitz baths and stool regulation, the anal fissure heals in most cases within 6–8 weeks. If it doesn't, a small operation or an injection of botulinum toxin into the sphincter will help.
- Stinging and burning when defecating
- Painful sphincter spasms
- Slight, bright red bleeding when defecating
- Itching around the anus with a chronic fissure.
When to the doctor
In the next few days if
- severe pain during bowel movements
- Blood deposits are visible on the stool.
It is not yet known exactly why the sensitive anal mucosa tears. One cause is said to be hard stool, which z. B. is pressed through the anus when constipated and injured the mucous membrane. Sometimes anal fissures also develop during childbirth due to the strong stretching of the skin in the area of the pelvic floor. Finally, the anal mucosa can also tear during sexual intercourse, e.g. B. during anal intercourse or sexual practices in which objects are pushed into the anus.
Poor blood circulation in the anal mucous membrane favors anal fissures - in two ways: Mucous membranes with poor blood circulation are more sensitive and tear more easily. It also hinders the healing process. A possible cause of poor blood flow to the mucous membranes is increased pressure in the sphincter muscle. Pain-related sphincter spasms are therefore partly responsible for the anal fissure if they do not want to heal.
Even if the mucous membrane is irritated by persistent diarrhea or previous inflammatory processes, it tears more easily. This happens, for example, with infectious diarrhea, food intolerance or a chronic inflammatory bowel disease. Anal fissures that develop due to another condition are also called secondary anal fissures.
The anal fissure is usually noticeable as a strong burning or stabbing pain when defecating. Sometimes there is also bright red blood on the toilet paper or in the toilet, which is why patients often mistake the anal fissure for hemorrhoids. The pain can be so severe that people avoid bowel movements, causing constipation. This starts a vicious circle: the constipation hardens the stool, the (inevitable) bowel movement hurts even more, the pain causes the anal area and the sphincter to cramp, excretion becomes even more difficult, the fear of the next bowel movement becomes even greater and the next urge to defecate again suppressed.
The spontaneous, acute anal fissure usually heals within 6–8 weeks. If the anal fissure persists for more than 8 weeks, it is a chronic anal fissure. Chronic anal fissures are characterized by the fact that they do not heal at all or only superficially and that they tear open again and again.
The chronic anal fissure is a wound into which germs from the intestine constantly migrate. Therefore, the risk of infection with chronic anal fissures is high. Consequences of such bacterial infections are z. B. Anal abscess or anal fistula. In addition, the chronic inflammatory processes in the anal mucosa often lead to the formation of skin thickening or skin folds. These folds of skin will be Outpost folds called. Although they are harmless, they interfere with anal hygiene and can in turn promote inflammation.
Pain during bowel movements and bright red blood on the stool are typical signs of an anal fissure for the doctor. The diagnosis is confirmed by the clinical examination of the anus. The doctor spreads the buttocks and recognizes the anal fissure, which is usually in a typical location. In addition, the doctor carefully palpates the anus; sometimes a proctoscopy or rectoscopy is necessary to rule out other anal diseases. Due to the severe pain, the doctor only performs these examinations under local anesthesia.
Differential diagnoses. Pain during bowel movements and blood on the stool also occur in numerous other diseases of the anus. The most important are the anal fistula, hemorrhoids, perianal thrombosis and anal carcinoma (a rare but increasingly common tumor in the anal canal or outside the anus).
Acute anal fissure. The treatment of the anal fissure is initially carried out with ointments, stool regulation and baths and takes about 6–8 weeks. Various active ingredients and measures are available to the doctor for therapy:
- Easy laxativeto soften the stool, e.g. B. Macrogol
- Pain relieving ointments with a local anesthetic such as B. Lidocaine (e.g. Posterisan®akut) against burning and stinging
- Antispasmodic ointments, e.g. B. with isosorbide dinitrate, glycerol trinitrate (e.g. Rectogesic®) or diltiazem, which lower the increased pressure in the sphincter. This relaxes the sphincter muscle, improves blood circulation, promotes healing and makes it easier for the patient to settle the stool. Since the active ingredients also get into the bloodstream via the ointment and expand the blood vessels there, they can trigger headaches, lower blood pressure and increase the effect of cardiovascular drugs. Therefore z. B. Patients with heart disease or arteriosclerosis do not use these ointments. The simultaneous use of sexual enhancers for the treatment of erectile dysfunction such as B. Sildenafil (e.g. Viagra®) should be avoided as there is a danger of a dangerous drop in blood pressure.
- Carefully stretch the anus several times a day with a Anal stretcher to relax the cramped sphincter muscles. To make it easier to insert, the tip is smeared with petroleum jelly
- Hip baths with chamomile extract or tanning additives (e.g. Tannolact®) to support the healing process. Warm too Tub baths are helpful because they relax all of the muscles
- Injection of Botulinum toxin A in the sphincter. Some doctors recommend the injection in the acute phase, others only when the ointment therapy does not heal the fissure. A single local injection relaxes the sphincter muscle in the area of the anal fissure for about 2 months. This not only makes the pain disappear, the fissure also heals better. The disadvantage of this treatment is the cost that the patient has to bear himself. In addition, the method leads to temporary incontinence in every 10th patient.
Chronic anal fissure. If an anal fissure does not heal within about 8 weeks, doctors will consider surgery to prevent the above complications.
With this so-called Fissurectomy according to Gabriel the doctor carefully cuts the pathological changes (ulcers, scarred changes, disturbing skin folds such as the outpost fold) out of the anal mucous membrane. The procedure is usually carried out on an outpatient basis under local anesthesia; the surgical wound takes about 6–8 weeks to heal.
Unfortunately, the operation harbors the risk of injuring the sphincter muscle and causing the patient to become incontinent.
90% of acute anal fissures heal without consequences within 6–8 weeks under therapy.
Your pharmacy recommends
What you can do yourself
- Avoid constipation. Eat a diet rich in fiber, drink plenty of fluids and exercise regularly (detailed self-help tips on constipation).
- Instead of suppressing the urge to defecate, go to the toilet as soon as the chair answers.
- If you do anal sex, use lubricant.
AuthorsDr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:38
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