Anal Fissure

What Is an Anal Fissure?

Anal fissure is a small  oval shape tear in skin that line the opening of the anus. Fissure typically causes the pain and bleeding while passng stools. Most common in general population , but are often confused with other causes of pain and bleeding , such as haemorrhoids.

Anal fissure can occur in both gender and have equal gender distribution. Most (85-90%) fissures occur in the posterior (back) midline of the anus with about 10-15% occurring in the anterior (front) midline. A small number of patients may actually have fissures in both the front and the back locations. Fissures located elsewhere (off to the side) should raise suspicion for other diseases (see below) and will need to be examined further.

What are the symptoms of the anal fissure?

The typical symptoms of an anal fissure include pain and bleeding with bowel movements. Patients note severe pain during, and especially after a bowel movement, lasting from several minutes to a few hours. Patients often notice bright red blood from the anus that can be seen on the toilet paper or on the stool. Between bowel movements, patients with anal fissures are often relatively symptom-free. Many patients are fearful of having a bowel movement and may try to avoid defecation secondary to the pain.

What causes an anal fissure?

Fissures are usually caused by trauma to the inner lining of the anus. A hard, dry bowel movement is typically responsible, but loose stools and diarrhea can also be the cause. The inciting trauma to the anus produces severe anal pain, resulting in anal sphincter spasm and a subsequent increase in anal sphincter muscle pressure. The increase in anal sphincter muscle pressure results in a decrease in blood flow to the site of the injury, thus impairing healing of the wound.

Anal fissures may be acute (recent onset) or chronic (typically lasting more than 8-12 weeks). Acute fissures may have the appearance of a simple tear in the anus, whereas chronic fissures may have swelling and scar tissue present. Chronic fissures may be more difficult to treat and may also have an external lump associated with the tear, called a sentinel pile or skin tag,as well as extra tissue just inside the anal canal, referred to as a hypertrophied papilla.

Quite commonly, anal fissures are misdiagnosed as hemorrhoids by the patient or the primary care physician due to some similar symptoms between the two. This delay in diagnosis may lead to an acute fissure becoming a chronic one and, thus, more difficult to treat. Less common causes of fissures include inflammatory conditions and certain anal infections or tumors, such as Crohn’s disease, ulcerative colitis, syphilis, tuberculosis, leukemia, HIV/AIDS, or anal cancer. These diseases cause atypical fissures that are located off the midline, are multiple, painless, or non-healing after proper treatment.

What is the treatment of anal fissures?

The majority of anal fissures do not require surgery. The most common treatment for an acute anal fissure consists of making one’s stool more formed and bulky with a diet high in fiber as well as utilizing over-the-counter fiber supplementation (totaling 25-35 grams of fiber/day). Stool softeners and increasing water intake may be necessary to promote soft bowel movements and aid in the healing process.

According to ayurveda fissure called as parikarthika, commom causative factor is vitiated vatadosha and imbalanced agni( digestive power). By keeping these principles in mind, we have to treat fissures with ayurveda medicines and procedures.

Dr saraja’s ayuveda anorectal hospital gives best treatment solutions for fissure cases with multidimentional approach like oral medication which are having properties of deepana, pachana, rechana and vatanulomana, which corrects our agni(digesive and metabolic fire) and for localised wound matra vasti(medicated oil enema) which reduces the vata and relaxes the sphincter spasm, which allows the wound to heal properly.

In chronic fissures, pt may need dilation procedure( sphincterolysis) with above medication. This sphincterolysis procedure bases on the patient condition, we perform with agnikarma( laser sphincterolysis) or with digital sphincterolysis or with sphincterolysis with cataract knife. These procedures gives immediate relaxation of sphictertone, within 2 days patient gets pain relief while passing stools.

All these procedures we can perform in local anaesthesia in a day care. Pt can go home with in 2 hours after procedure, can do his regular activities from next day.

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