Anal Fissure | Difference from piles | Symptoms | Diagnosis | Treatment Ever felt that sharp, burning and extreme pain while passing a stool? Noticed blood in stool? It could be an Anal Fissure (Fissure in Ano)
Dr. Abhimanyu Kapoor, brings yet another simplified VLOG on the causes, symptoms, diagnosis and treatment of an extremely painful and common problem – Anal Fissures.
Often patients confuse Anal Fissures to piles and this video clarifies every FAQ that surrounds the confusion. Also, the video explains the step wise procedures that don’t just cure the pain but also save the patient from experiencing it again.
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Anal Fissure –
Anal Fissure is a linear ulcer or laceration located just inside the anal verge. Most commonly this ulcer is located in the midline posteriorly. It is a very common problem afflicting the Anus.
What are its causes?
It is caused by trauma to the anal canal, because of passage of hard stools. Therefore it is almost always associated with constipation. Infrequently it may occur after diarrhea because of frequent defecation.
The pain due to fissure is associated with muscle (sphincteric) spasm and this increases the anal pressures that reduce the mucosal blood flow further. Pain, spasm, reduced blood flow and recurrent passage of hard stool do not allow the fissure to heal and lead to worsening of the problem.
What are the problems associated with anal fissure?
Patients with Anal Fissure suffer from severe pain in the anus at the time of passing stool. Characteristics of Pain:
- Occurs at the time of defecation
- Can continue for a long time afterwards
- Severe burning sensation
- Pain can be so severe that patient may be afraid of passing stool!
Sometimes along with pain, patients with Anal Fissure can also experience bleeding at the time of defecation. Characteristics of Bleeding:
- Fresh red in color
- Found on tissue when cleansing after bowel movement
- As a linear blood streak over the stool
How to Diagnose?
Anal Fissure is easily diagnosed on physical examination. The linear fissure can be noticed by gently parting the buttocks without causing discomfort to the patient. There is usually a swollen skin tag at the edge of the fissure – it is known as a “Sentinel Pile”. The spasm of the anal sphincter can be appreciated and the condition is so painful that the patient usually does not allow a rectal examination with finger.
Medical Treatment
- Sitz Bath
- Local Anaesthetic Gel
- Smooth Muscle relaxant Gel
- Laxatives / Stool Softeners
Analgesics Upto 80% of patients suffering from Acute fissure have marked improvement with medical treatment. However the success rate is only 40% in patients with Chronic fissure. About 60 % can develop recurrence of Fissure after medical treatment.
Surgical Treatment Surgery is offered once medical treatment fails to provide relief of symptoms or if fissure does not heal despite medical treatment. Most effective surgery for fissure is – Partial Lateral Internal Sphincterotomy. This surgery hardly takes five minutes. In this, part of the internal sphincter – which is in spasm is divided. This leads to relief in spasm and improves the mucosal blood supply, this leads to healing of the anal fissure and provides instant relief in pain. Patients can go home on the day of surgery. They can pass motion normally from the next day itself and do not require any dressing.
Prevention
- Avoid stress by all means. Stress is a usual culprit. Stress leads to constipation and problems like fissure.
- Drink plenty of water and healthy liquids
- Consume green vegetables and high fiber diet
- Stay away from junk food, oily and spicy meals
- Exercise regularly and do not put on excessive weight