Fissure

What is Anal Fissure?

An Anal fissure is a small crack or tear or ulcer (open sore) in your skin in ano-rectal region. Fissures are characterized by extreme Pain, Burning sensation & needle pricking sensation during defecation & in extreme cases throughout the day also. Sometimes fissure causes bleeding also. About one in 10 people get an anal fissure at some point in their life. Anal fissures usually develop at the part of your anus towards your back – in line with the cleft of your buttock or in front of your anus, or even both together. An anal fissure will usually heal within five to six weeks, and it’s called an acute anal fissure. If it lasts for longer than this it’s known as a chronic anal fissure. Anal fissure can come at any age, but it’s most common in people aged 20 to 50.

Symptoms of Anal Fissure’s :-

In Anal fissure, you can have the following symptoms.

☛ A sharp, searing or burning pain in, or around, your bottom, which can last for a couple of hours after you go to the toilet. Some people describe the pain of an anal fissure as like passing broken glass.
☛ Spasms in anus.
☛ Sometimes small Bleeding during defecation.
☛ A sentinel pile. This is a tag of skin that can develop on the edge of your anus below the fissure. This can develop after you get the fissure.

These symptoms may be caused by something other than an anal fissure. One condition they’re often confused with is piles (haemorrhoids), for example. If you have any of these symptoms, contact your Doctor.

Diagnosis of anal Fissure

Initially General Physician will check the symptoms & will examine the anal area to check the fissures. He will prescribe you with some basic treatments of fissure. However if the symptoms of fissure will not go in 5-7 weeks, GP may refer you to see a colorectal surgeon. He will suggest some other tests to find out other bowel problems, such as a proctoscope test. This involves using a narrow tube to look at the inside of your rectum and large bowel. Or an ultrasound scans. After examining you carefully again he further will suggest for next treatment plan or Fissure surgery.

Self-help in Anal Fissure

After diagnosed with Anal Fissure there are some basic changes related to diet & lifestyle. It’s important to keep your faeces soft & smooth bowels. This will help to stop you stretching your anus, and with the pain caused by the fissure. There are following precautions :-

☛ Eating a healthy balanced & fibre rich diet.
☛ Taking a fibre supplement like psyllium husk (isabgol).
☛ Drinking enough fluids so you don’t become dehydrated.
☛ Avoiding oily & fat rich heavy food.
☛ Lite but regular exercise.
☛ Warm Sitz Bath (5–10 minutes) helping in easing discomfort & inflammation.

Causes of Anal Fissure

There are lots of reasons for having anal fissure however most commonly it is caused by a hard or painful bowel movement, which damages the surrounding skin. Some other reasons for Anal Fissure are :-

☛ Straining during bowels – sometimes due to constipation.
☛ Improper eating habits & lifestyle.
☛ Severe diarrhoea.
☛ Inflammatory bowel disease, such as Crohn’s disease.
☛ Having an infection in the skin around your anus, e.g. sexually transmitted infection.
☛ Because of taking painkillers for long term, that contain opiate.
☛ Trauma – for example, through having anal sex.
☛ Anal cancer
☛ Pregnancy.

Treatment of Anal Fissure

Generally an anal fissure will heal within few weeks without any treatment. An anal fissure usually heals if you make some dietary & lifestyle changes along with medicines, or use creams. If it doesn’t get better, generally Doctors advice for surgery.

Fissure Medicine

Always read the instruction manual that comes with your medicine and if you have any questions, ask your doctor for advice. Your Doctor may recommend you a laxative or pain killers or medicine or injections for treating anal spasms Laxatives or stool softeners- Such as lactulose syrup, or natural fibre like isabgol to soften your stools. You can purchase laxatives as a OTC product directly from a pharmacist without a prescription too. But, it’s important to talk to your Doctor before using any laxatives because there are different types that work with different mechanisms Painkillers for Fissure- Fissures generally causes severe pain (needle pricking) & burning sensation. For getting relief you can use over the counter painkillers s like paracetamol, ibuprofen, or diclofenac, in case if doesn’t work, immediately contact your Doctor

Medicine for Anal Spasms in Fissures

The opening and closing of your anus & therefore your bowels are controlled by your anal sphincter muscles that surround your anus. If you have an anal fissure, your internal anal sphincter will get spasms (tenses). This reduces the blood supply to your fissure and prevents its healing. Local anaesthetic like lidocaine or Glyceryl trinitrate helps the internal sphincter muscle to relax. It reduces the spasm and improves blood flow to help the fissure heal. Injections of Botulinum A toxin (eg, Botox) is also injected in your internal sphincter muscle to help it relax & therefore very commonly used by surgeons to treat anal fissure. Alternative Medicine for Anal fissure.
Olive oil or coconut oil are rich in healthy fats that will lubricate your bowel system, allowing the stool to pass easily. Other useful things are Aloe Vera, Hot Sitz Bath, Comfrey, Coconut Oil, L-arginine Gel. Ayurvedic therapies like ksharasutra or thread therapy & Specific Asanas, Panayamas, mudras also plays a significant role in fissure healing.

Fissures Surgery

Surgery may be needed if medicine fails to heal a fissure in the anus. The preferred procedure is an internal anal sphincterotomy. In this procedure Surgeon makes a small incision in the internal anal sphincter, one of two muscles that control the bowels or opening or closing of anus. This will be done under local or general anaesthesia. The internal anal sphincter is always under tension, also known as resting pressure. If that pressure becomes too high, a fissure may form or an existing one may not heal. The incision reduces the resting pressure, allowing the fissure to heal. Even with surgery, an anal fissure must heal on its own. A sphincterotomy involves operating on the sphincter muscles, not closing the actual fissure.

Lateral internal sphincterotomy :-

Lateral internal sphincterotomy highly preferred treatment of fissure due to its high success rate (~95%) & easier process. In this treatment the internal anal sphincter is partially divided in order to reduce spasms and thus improve the blood supply to the perianal area.This treatment of fissure improvement in the blood supply helps to heal the fissure.This is a single day &simple surgery. However, this have a number of potential side effects like problems in incision healing and also loss of stool holding capacity and sometimes loss of urination senses also.

Anal dilation :-

Anal dilation or stretching of the anal canal also known as Lord’s operation is one of the older treatment of fissure, which is not very common, primarily due to the unacceptably high incidence of fecal incontinence & flatus incontinence.

Prevention of Anal Fissure

You can reduce your risk of developing an anal fissure by preventing constipation along with some dietary & lifestyle changes. Constipation can be controlled by taking a healthy balanced diet that contains plenty of fibre, fruit and vegetables, making a correct fluid balance in body, and exercising regularly. Also you can use some natural fibres like isabgol for making the bowels proper & regular.

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