Fissure-In-Ano

Fissure-in-ano: Introduction

Anal fissures, also medically called as Fissure-in-ano, is nothing but a painful conditions where there is a longitudinal cut on the skin of anus. Due to friction or scratch or trauma, there may be a cut or fissure formation. Males, females including adults as and children may get affected with Fissure-in-ano.

The rear part of anus is a common spot affected due to poor blood supply, leading two formation of fissure and difficult healing. Some conditions such as constipation, chronic diarrhea, ulcerative colitis, Crohn’s disease, etc. could trigger or lead to fissure formation.

Common Symptoms of Fissure-in-ano

01 Pain while passing motions: Painfulness of the anus where there is a cut, is the most common symptom. The pain typically described by the patient is as cutting, shooting, agonizing, burning or even excruciating. It may last for a few hours after passing stool due to friction, fresh trauma, inflammation and infection. It would start soon while passing stool, at times, preventing the defecate. Children may avoid passing stool due to anticipated pain. If patient has consumed spicy food, there could be burning while passing stool; and afterwards. The pain may subside after a few minutes or few hours; to re-appear after the next call for passing stool.
02 Severe anal spasm (as a protective reflex)
03 Hard stool may cause friction on the wall of anus giving blood streaked stool. There may be frank bleeding after passing stool, which is likely to be bright red in color.
04 Itching, Discharge, swelling are common symptoms of chronic fissures.
Types of Fissure-in-ano
Fissure-in-ano may be acute (less than 6 weeks of duration) fissure or chronic (more than 6 weeks of duration) or recurring fissures.
Fissure-in-ano is largely considered as a medico surgical disorder. However, looking at it in the light of homeopathic medicine, it is medically correctible conditions. It is possible to avoid surgery using homeopathy, in most cases.

Causes of Fissure-in-ano:

Most common cause of the fissure-in-ano is constipation. Chronic constipation due to any reason (such as due to lifestyle, habitual, drug induced, due to pregnancy, etc.) leads to recurring abrasion or forceful rubbing of the anal mucosa, which leads to a fissure. The current theory also suggests that sphincter spasm and accompanying ischaemia ;may precipitate the development of fissures and prevent them from healing in some people. The other less common causes can be

  • Following a bout of diarrhea or following passage of bulky or hard stools (especially in children)
  • Multiple pregnancies
  • Chronic use of purgatives
  • Rarely, a fissure may be the manifestation of underlying disease e.g. Crohn’s disease, ulcerative colitis, sexually transmitted disease, or cancer.
  • Wrongly performed operation for piles

When choosing the homeopathic remedy for fissure, the causative factors are always evaluated, and homeopathic medicine encompassing this cause is chosen. Remedy chosen in such way not only heals the fissure, but also does not allow the problem to recur.

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Diagnosis of Fissure

The diagnosis of fissure-in-ano is easy to make clinically and usually no complicated procedures are required to diagnose this condition. Examination by a proctoscope is better avoided. Physician will usually try to avoid putting any instrument in the anus, as the area is extremely sensitive and such examination can be very painful. In majority of cases, with careful evaluation of the symptoms and a close look at the anus, a diagnosis of fissure can be confirmed by a trained doctor.

On examination, the doctor may observe following:

  • Spasm of the anus
  • A split or cut in the posterior midline of the anal mucosa.
  • Lateral fissures: If fissure is observed laterally, instead of posterior midline location of fissure, it may give hint to underlying diseases such as Crohn’s disease, ulcerative colitis, or sexually transmitted diseases. In such cases fissures are usually multiple and may have atypical appearance.
  • Acute fissures (usually present for 6 weeks or less) are superficial with sharply demarcated edges.
  • Chronic fissures (present for more than 6 weeks) are usually deeper and may have secondary features, including hardening of the edge of the fissure, a sentinal pile which looks like small skin tag, and hypertrophied anal papillae, etc.

Future of Fissure

Prognosis:

The vast majority of acute fissures resolve entirely within a short span of time, if there is no constipation or straining for the toilet.

Complications:

If acute fissures are not properly managed, they become chronic. Chronic and non-healing fissure-in-ano may present as a complicated condition, especially when it is associated with resistant constipation,
01 Hemorrhoids (piles): Hemorrhoids are swollen, dilated veins of the rectum or anus. Hemorrhoids may be located at the beginning of the anal canal (internal hemorrhoids), or at the anal opening (external hemorrhoids).
02 Anorectal fistula: Anorectal fistula is a hollow tract (opening) leading from the anal canal or rectum to the skin through which watery pus drains.
03 Crohns disease: Crohn s disease is a chronic inflammatory process primarily involving the intestinal tract. It most commonly affects the last part of the small intestine (ileum) and/or the large intestine (colon and rectum). Also called as regional enteritis and ileitis.
04 Anorectal cancer: Cancer affecting rectum and anus.
05 Perianal abscess: Perianal abscess is a collection of pus outside the anus.
Chronic and recurring fissures may lead to permanent scarring or injury that prevents normal bowel movements.

Timely administered homeopathic medicines take care of acute and chronic fissures gently, effectively, and without producing any side effects.

Self Help For Fissure

01 Diet – As constipation is the main culprit behind fissure-in-ano, all steps to avoid constipation will help to a great extent. A high-fiber diet and extra fluids to prevent constipation are recommended. This means eating more fruits, vegetables, cereals, whole meal bread, etc. and drinking at least 8 glasses (12 cups) of water a day. Reduced intake of coffee and alcohol also helps.
02 To relieve pain Apply a warm towel to the area. Warm baths or Sitz baths also relieve pain. Use 8 inches of warm water in the bathtub, 2 or 3 times a day for 5-10 minutes. Do not expose the anal skin to hot bath water or hot shower water. Use only luke-warm water on this area.
03 Physical activity – No restrictions are necessary. In fact, physical activity reduces the likelihood of constipation.
04 To prevent infection, gently clean the anal area with soap and water after each bowel movement. Do not put any creams or ointments, cornstarch, talcum or other powder, witch hazel, or anything else on or into the anus.
05 To prevent recurrence – 1. Avoid constipation by drinking at least 8 glasses of water daily and eating a diet high in fiber. 2. Develop regular bowel habit. Do not suppress desire of passing stools as this results in hard and large stools, which usually produces injury to the anus. 3. Avoid straining at stools. 4. Avoid anal intercourse

Fissure in ANO Conventional Treatment

  • To relieve constipation:> Medicines used to relieve constipation are either bulk forming agents or stool softeners. These agents usually produce soft stools that gently dilate the anal sphincter. Common Bulk-forming agents including bran, ispaghula husk, sterculia etc. The only shortcoming of these agents is that they do not relieve habitual tendency of the patient to have constipation. Hence individuals usually get used to or habituated to such kind of medicines.
  • To relieve pain: Creams or ointments that contain pain-killiers are used. These include NSAIDs (non-steroidal anti-inflammatory drugs) and corticosteroids. However, their role in healing the fissure-in-ano is unclear. Moreover, they cannot be used for more than 5-7 days, as they may irritate the skin around the anus.
  • To control infection: Antibiotic creams are used to control local infection.
  • To assist healing process: Glyceryl trinitrate ointment helps healing of the fissure. Side effect of this treatment includes headaches. If the headaches are troublesome, this may not be the right treatment for you.

Fissure in Ano Causes

Most common cause of the fissure-in-ano is constipation. Chronic constipation due to any reason (such as habitual, drug induced, pregnancy, etc.) leads to recurring abrasion or forceful rubbing of the anal mucosa, which leads to a fissure. The current theory also suggests that sphincter spasm and accompanying ischaemia may precipitate the development of fissures and prevent them from healing in some people. The other less common causes can be

  • Following bout of diarrhea or following passage of bulky stools very quickly (especially in children)
  • Multiple pregnancies
  • Chronic use of laxatives
  • Rarely, a fissure may be the manifestation of underlying disease e.g. Crohn’s disease, ulcerative colitis, sexually transmitted disease, or cancer.
  • Incorrectly performed operation for piles

When choosing the homeopathic remedy for fissure, the causative factors are always evaluated, and homeopathic medicine encompassing this cause is chosen. Remedy chosen in such way not only heals the fissure, but also does not allow the problem to recur.

Fissure in Ano Symptoms

  • Pain while passing stools: The lower anal canal is exquisitely sensitive area of skin and can produce fairly significant signals of pain if damaged. Sharp agonizing knife-like pain starts when the individual passes stool. The pain is severe and persists for an hour or so. It ceases suddenly. The sufferer is comfortable until the next action of bowel. The individual tends to be constipated rather than go through painful ordeal. If a fissure becomes chronic (long-standing) and deep, another kind of pain can develop. It is a dull ache in the anus and pelvis that starts a few minutes after the bowel movement and can persist for hours after passing stools. This chronic fissure pain is due to spasm of the internal sphincter muscle (one of the small muscles in the anus) and can be quite debilitating.
  • Severe spasm of the anal sphincter (as a protective reflex)
  • Blood streaked stool (typically on the side of the hard stool) : It is important to note that the bleeding associated with a fissure-in-ano is bright red and associated with some pain or tenderness in the anus. Dark bleeding of greater amount without any anal tenderness or pain should never be ignored and should be brought to the notice of doctor.
  • Discharge, swelling, and itching occur especially with chronic fissures. Interestingly, homeopathy has many medicines to relieve the discomfort. Rightly chosen homeopathic medicine covers various aspects of fissure.

Types of Fissure-in-ano

Fissure-in-ano may present as acute fissure of recent origin (less than 6 weeks of duration). At this stage fissures are superficial. Some of them may deepen to reach underlying layers and present as chronic fissure of a long duration (more than 6 weeks of duration) or recurring fissures.

Fissure-in-ano is largely considered as a medico surgical disorder. However, looking at it in the light of homeopathic medicine, it is medically correctible conditions. Fortunately, in most cases, surgery can be avoided with homeopathy treatment.

Fissure in Ano Diagnosis

The diagnosis of fissure-in-ano is easy to make clinically and usually no complicated procedures are required to diagnose this condition. Physician will usually try to avoid putting any instrument in the anus, as the area is extremely sensitive and such examination can be very painful. In majority of cases, with careful evaluation of the symptoms and a close look at the anus, a diagnosis of fissure can be confirmed by your doctor.

On examination, the doctor may observe following:

  • Spasm of the anus
  • A split or cut in the posterior midline of the anal mucosa.
  • Lateral fissures: If fissure is observed laterally, instead of posterior midline location of fissure, it may give hint to underlying diseases such as Crohn’s disease, ulcerative colitis, or sexually transmitted diseases. In such cases fissures are usually multiple and may have atypical appearance.
  • Acute fissures (usually present for 6 weeks or less) are superficial with sharply demarcated edges.

– Chronic fissures (present for more than 6 weeks) are usually deeper and may have secondary features, including hardening of the edge of the fissure, a sentinal pile which looks like small skin tag, and hypertrophied anal papillae, etc.

Prognosis & Complications

Fissure in Ano Complications

Prognosis:

The vast majority of acute fissures resolve entirely within a short span of time, if there is no constipation or straining for the toilet.

Complications:

If acute fissures are not properly managed, they become chronic. Chronic and non-healing fissure-in-ano may present as a complicated condition, especially when it is associated with resistant constipation.
01 Hemorrhoids (piles): Hemorrhoids or piles are swollen, dilated veins of the rectum or anus. Hemorrhoids may be located at the beginning of the anal canal (internal hemorrhoids), or at the anal opening (external hemorrhoids).
02 Anorectal fistula: Anorectal fistula is a hollow tract (opening) leading from the anal canal or rectum to the skin through which watery pus drains.
03 Crohns disease: Crohn’s disease is a chronic inflammatory process primarily involving the intestinal tract. It most commonly affects the last part of the small intestine (ileum) and/or the large intestine (colon and rectum). Also called as regional enteritis and ileitis.
04 Anorectal cancer: Cancer affecting rectum and anus.
05 Perianal abscess: Perianal abscess is a collection of pus outside the anus.

Chronic and recurring fissures may lead to permanent scarring or injury that prevents normal bowel movements.

Timely administered homeopathic medicines take care of acute and chronic fissures gently, effectively, and without producing any side effects.

Fissure in Ano Self Treatment

1. Diet

As constipation is the main culprit behind fissure-in-ano, all steps to avoid constipation will help to a great extent. A high-fiber diet and extra fluids to prevent constipation are recommended. This means eating more fruits, vegetables, cereals, whole meal bread, etc. and drinking at least 8 glasses (12 cups) of water a day. Reduced intake of coffee and alcohol also helps.

2. Relieve Pain

To relieve pain apply a warm towel to the area. Warm baths or Sitz baths also relieve pain. Use 8 inches of warm water in the bathtub, 2 or 3 times a day for 5-10 minutes. Do not expose the anal skin to hot bath water or hot shower water. Use only luke-warm water on this area.

3. Physical activity

No restrictions are necessary. In fact, physical activity reduces the likelihood of constipation.

4. Prevent Infection

For preventing infection gently clean the anal area with soap and water after each bowel movement. Do not put any creams or ointments, cornstarch, talcum or other powder, witch hazel, or anything else on or into the anus.

5. To prevent recurrence

  • Avoid constipation by drinking at least 8 glasses of water daily and eating a diet high in fiber.
  • Develop regular bowel habit. Do not suppress desire of passing stools as this results in hard and large stools, which usually produces injury to the anus.
  • Avoid straining at stools.
  • Avoid anal intercourse.

Fissure in Ano Glossary: Related Medical Terms for Anal Fissure

Anus : The opening at the end of the digestive tract where bowel contents leave the body.

Anal mucosa : Inner lining of anus.

Anal spasm : Tightening or tension in the anus.

Anal warts : Anal wart is a viral condition (caused by human papilloma virus). They first appear as tiny blemishes, perhaps as small as the head of a pin, and may grow larger than the size of a pea.

Anorectal cancer : Cancer affecting rectum and anus.

Anorectal fistula : Anorectal fistula is a hollow tract (opening) leading from the anal canal or rectum to the skin through which watery pus drains.

Crohn’s disease : Crohn’s disease is a chronic inflammatory process primarily involving the intestinal tract. It most commonly affects the last part of the small intestine (ileum) and/or the large intestine (colon and rectum). Also called as regional enteritis and ileitis.

Hemorrhoids (piles) : Hemorrhoids are swollen, dilated veins of the rectum or anus. Hemorrhoids may be located at the beginning of the anal canal (internal hemorrhoids), or at the anal opening (external hemorrhoids).

Hypertrophied anal papillae : Hypertrophied anal papillae are essentially skin tags that project up from the dentate line (the junction between the skin and the epithelial lining of the anus). They are often found as part of the classic triad of a chronic fissure, which includes the hypertrophied papilla above, the fissure, and a skin tag below (sentinal pile).

Ischemia : Less blood supply.

Lateral : On the sides.

Perianal abscess : Perianal abscess is a collection of pus outside the anus.

Pilonidal cyst : A pilonidal cyst or sinus is an abscess (localized collection of pus) or a chronic draining sinus (canal or passage leading to an abscess) located in the opening between the buttock muscles. This cyst may have a deep cavity containing hair and may be without symptoms unless it becomes infected.

Posterior : Backside of given object.

Rectal polyp : Polyps are stalk-like tumors or outgrowths in the rectum.

Sentinal pile : It looks like small skin tag and actually is a vein that has dropped down from inside of the anus to lie outside.

Ulcerative colitis : Ulcerative colitis is an inflammation of the lining of the large bowel (colon).

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