by Dr Rajesh Pendlimari | May 10, 2021

Anal fissure also commonly called as Fissure-in-ano is the commonest cause for you to meet a

proctologist.

It is nothing but a small tear in the thin, moist tissue that lines the anus. An anal fissure may occur when

you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and

bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of

your anus (anal sphincter).

What do I experience when I develop an Anal fissure?

Pain, sometimes severe, during bowel movements

-Pain after bowel movements that can last up to several hours

-Bright red blood on the stool or toilet paper after a bowel movement

-A visible crack in the skin around the anus

-A small lump or skin tag on the skin near the anal fissure

What would have caused my anal fissure?

-Passing large or hard stools

-Constipation and straining during bowel movements

-Chronic diarrhea

-Anal intercourse

-Childbirth

-ALess common causes of anal fissures include: Crohn’s disease or another

inflammatory bowel disease, Anal cancer, HIV, Tuberculosis, Syphilis

Who is high risk for developing an Anal fissure?

Constipation. Straining during bowel movements and passing hard stools increase the

risk of tearing.

Childbirth. Anal fissures are more common in women after they give birth.

Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the

intestinal tract, which may make the lining of the anal canal more vulnerable to

tearing

Anal intercourse

More common in infants and middle-aged adults 

What are the complications of Anal fissure? Failure to heal. An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment.

Recurrence. Once you’ve experienced an anal fissure, you are prone to having another one .

A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure.

Can I prevent Anal Fissure?

You may be able to prevent an anal fissure by taking measures to prevent constipation or

diarrhea. Eat high-fiber foods, drink fluids and exercise regularly to keep from having to

strain during bowel movements.

How is the anal fissure treated?

Anal fissures often require few weeks to completely heal if you take steps to keep your stool

soft, such as increasing your intake of fiber and fluids.

There are THREE modalities in the management of fissure

Medications -

Externally applied nitroglycerin or diltiazem help increase blood flow to the

fissure and promote healing and to help relax the anal sphincter. Side effects may

include headache, which can be severe.

Topical anesthetic creams such as lidocaine hydrochloride may be helpful for pain

relief.

 Laxatives and fiber supplementation – eases the

consistency and decrease the strain for your anal muscle

during passing stools.

Injection of Botulinum toxin –

Botulinum toxin type A (Botox) injection, to paralyze the anal

sphincter muscle and relax spasms. It is safe and done in the

OPD

Surgery

If you have a chronic anal fissure that is resistant to other treatments, or if your

symptoms are severe, your doctor may recommend surgery. Doctors usually

perform a procedure called lateral anal sphincterotomy (LAS), which involves

cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and

promote healing.

Laser Surgery has shown no benefit than the traditional surgery.

Studies have found that for chronic fissure, Botulinum injection and surgery is much more

effective than any medical treatment.

Are there any lifestyle changes and home remedies that help along with medications?

• Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep
• stools soft and improve fissure healing. Fibre-rich foods include fruits, vegetables,
• nuts and whole grains. You also can take a fiber supplement. Adding fiber may
• cause gas and bloating, so increase your intake gradually.
• Drink adequate fluids. Fluids help prevent constipation.
• Avoid straining during bowel movements. Straining creates pressure, which can
• open a healing tear or cause a new tear.

_____________________________________________________________________________________________________

Read more :