Anal Fissure

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An anal fissure is a small cut or tear in the lining of the anus. The crack in the skin causes severe pain and some bright red bleeding during and after bowel movements. At times, the fissure can … Read More

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Anal Fissure

Anal fissure is a small cut or tear in the lining of the anus. The crack in the skin causes severe pain and some bright red bleeding during and after bowel movements. At times, the fissure can be deep enough to expose the muscle tissue underneath.
An anal fissure usually isn’t a serious condition. It can affect people of all ages, and it’s often seen in infants and young children since constipation is a common problem in these age groups.

In most cases, the tear heals on its own within four to six weeks. In cases where the fissure persists beyond eight weeks, it’s considered chronic. Certain treatments can promote healing and help relieve discomfort, including stool softeners and topical pain relievers.
If an anal fissure doesn’t improve with these treatments, you may need surgery. Or your doctor may need to look for other underlying disorders that can cause anal fissures.

Symptoms

An anal fissure may cause one or more of the following symptoms:

• a visible tear in the skin around your anus
• a skin tag, or small lump of skin, next to the tear
• sharp pain in the anal area during bowel movements
• streaks of blood on stools or on toilet paper after wiping
• burning or itching in the anal area

Causes

An anal fissure most often occurs when passing large or hard stools. Chronic constipation or frequent diarrhea can also tear the skin around your anus. Other common causes include:

• straining during childbirth or bowel movements
• inflammatory bowel disease (IBD), such as Crohn’s disease
• decreased blood flow to the anorectal area
• overly tight or spastic anal sphincter muscles

In rare cases, an anal fissure may develop due to: anal cancer, HIV, tuberculosis, syphilis, herpes

FAQ

What are Anal Fissure?
Anal fissure is tear or ulcer in lower thin and delicate lining of anal canal occurring in midline mosly situiated in back side(posteriorly than anterior) which is common in middle age group of 20-40 yrs with no sex predilection.

What are the types of this disease?
It is of two types Acute and Chronic.Acute anal fissure is deep tear with spasm of anal sphincter which presents with severe pain associated while passing stool constipation. Chronic fissure is one which last for more than 6 week less painful than acute and generally accompanied by inflammation and skin tag along with ulcer.

Is the disease life threatening?
Anal fissure does not cause death. It can cause discomfort for long period of time and can cause complication like abscess and fistula formation but misdiagnosis as a anal fissure of other medical condition can prove fatal.

What are the causes of Anal Fissure?
The most common cause of anal fissure is hard stools which injures the lining of anal canal. Also diarrhea on the other hand can lead to development of anal fissure. Other causes include increased spincter tone , local intruppted blood supply, sexually transmitted disease, Anal sex and other local trauma, Haemorrhoids, Crohns disease, tuberculosis, ulcerative colitis etc.

What are the symptoms of Anal fissure?
Anal fissure causes pain and discomfort while passing stools which may include passing blood in poo.Constipation, Itching secondary to irritation, discharge from wound may accompany.

What are the natural cure or lifestyle changes I can adopt to prevent this disease?
Basically efforts should be made to avoid constipation or soften the stools to decrease pain while passing stool or to prevent advancement of disease which include
-Adequate water intake( 6-8 glasses of fluid )
-Addition of fiber rich substance in diet like whole grain, fruits like pear, orange , melon
-Bulk forming agent like husk, bran
-Having healthy stool habits and avoiding straining while passing stools.
-Also treatment of accompanied diarrhea should be done

What are long term complication of this disease?
It can lead to development of Anal abscess formation(which is infected ulcer) and subsequent fistula formation. Chronic cases are usually associated with anal tags which further adds to discomfort and can cause collection of blood.

How is this disease diagnosed?
The disease is diagnosed on rectal examination. Examination includes examining with finger under torch light or proctoscopy examination.

When should I undergo treatment?
One should not hesitate to see General Surgeon
1) If the pain and discomfort isn’t getting better after taking general measures.
2) Pain or discomfort gets worse or if your poo contains blood
3) Condition isn’t getting better even after 6 weeks of treatment.

What is treatment done?
Conservative treatment is aimed to eliminate the cause that is to soften the stools which include adequate water intake, stool softener, fiber rich diet. One can practice Sitz bath which include sitting in warm water 2-3 times in a day to relax spincter or to increase blood flow and hasten healing.

What is the medical treatment done?
Local application of lignocaine which numbs the area , relaxes the spincter and decreses pain. Your Doctor may prescribe drugs like Diltiazem (two times day) or other Calcium channel blocker ,Glyceryltrinitrate two or three times a day. Self medication is harmful.

When Surgical treatment done?
Surgical treatment is advocated when medical treatment fails or patient is at risk of complication.

What is surgical treatment done?
Dorsal fissureectomy with sphincterotomy is removal of fissure and incision of sphincter.
Lateral anal sphincterotomy consist of diving internal sphincter either right or left side . It has 90% success rate with nless chances of reoccurance.
Anal Advacement flap is newer method implied generally in females and those with lowor normal resting anal pressure. Edges of fissure are excised and skin overlying sphincter is mobilized over blood supply.
For acute cases stretching with finger under local anasethesia to relax the sphincter can be implied.

What is prescribed after Surgery?
Patients are generally maintained on stool softner, bulking agents and topican sphincter relaxents.

What are the complication of surgery?
Complication of surgery include haematoma formation,perianal bruising, fistula and incontinence.

How many days of hospitalisation is required after surgery?
Patient generally gets discharge on same day Or within 24-48 hours as it is day care surgery.

I am Hypertensive or Diabetic can I undergo this treatment?
Diltiazem causes headache and dizziness so you need to inform about your medical conditions and medication you are taking.

Which activities can I resume after this surgery?
You can perform all activities after surgery. No activities are contraindicated.