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