What is Anal Fissure and what are the alternative treatment options

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What is Anal Fissure

Anal Fissure
Anal fissure is a slight cut in the lining of the anus. The crack or tear in the anus causes severe pain and sometimes bleeding during and after defecation. Treatment options available vary from conservative treatment of diet modification to surgery.

Anal fissure is a slight cut in the lining of the anus. The crack or tear in the anus causes severe pain and sometimes bleeding during and after defecation. Treatment options available vary from conservative treatment of diet modification to surgery.

Anal fissure may occur due to childbirth, tension during the intestinal movements, or long bouts of constipation or diarrhea. Sometimes the tear is deep enough to show the muscle tissue. Anal fissure can affect people of all ages, and it is often seen by infants and young children. Constipation is a common problem in these age groups. Anal fissure is usually not a serious condition. In most cases the tear cures itself within four to six weeks. In cases where the fissure stays longer than eight weeks, it is considered to be chronic or long term. Certain treatments can promote cure and help relieve discomfort, such as stool feces and current painkillers. If an anal cleft is not improved with these treatments, surgery may be required.

The most common place for anal fissure is the midline posteriorly in the anal canal, the part of the anus close to the spine, because of the configuration of the muscle surrounding the anus. This muscle complex, referred to as the external and internal anal sphincter, guides and supports the anal canal. The sphincters are oval and are best supported on their sides and weakest back. If tears occur in the anoderm, they are probably posterior. In women, there is also weak support for the anal canal due to the presence of the vagina anterior to the anus. For this reason, 10% of the gaps in women are anterior, while only 1% is in men. At the bottom of fissures a skin can be formed, called a centinal pile.

Causes:

Anal fissures are caused by injury to the anus and anal canal tissues. The cause of the injruy is usually a hard stool due to constipation. The fissure can be caused by a repeated episodes of diarrhea. Sometimes insertion of a rectal thermometer, enema tip, endoscope or ultrasound probe (for the prostate gland) may result in sufficient trauma to cause a fissure. During labor, trauma to the perineum (the skin between the posterior vagina and the anus) may cause a tear that extends into the anoderm. Anaal fissures may also be due to certain medical conditions such as inflammatory bowel disease (IBD), infection and cancer.

Symptoms:

A sharp, stinging or burning pain during the stool. Pain of a fissure may be quite serious. It may be of short duration or last for a few hours after a bowel movement.

Itching or Burning sensation in anus

The blood of a fissure is separate from the stool. (Very dark, tarry stool or dark red blood mixed with stools can be a sign of a more serious problem.)  Severe spasm of anal sphincter

Diagnosis

Physical Exam:

Looking at the fissure by gently separating the buttock

Digital rectal Exam

By inserting a gloved finger into anal canal.

Anoscopy:

This involves using a short, lighted scope to look into the anal canal.

Flexible sigmoidoscopy 

A thin, flexible tube with a tiny video is inserted into the bottom portion of colon.

A flexible tube is inserted into rectum to inspect the entire colon.

Treatment

Avoid Constipation: Anal fissures usually heal within a few weeks if one take precautions to keep stool soft, by increasing intake of fiber and fluids.

Sitz Bath: Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing.

If symptoms persist, need further treatment.

Nonsurgical Treatments

  • Externally applied nitroglycerin Ointment – It help increases blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe.
  • Topical anesthetic creamssuch as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief.
  • Botulinum toxin type A (Botox) injection,to paralyze the anal sphincter muscle and relax spasms.
  • Blood pressure medications, Oral nifedipine or diltiazem relax the anal sphincter. These medications may be taken orally  or applied externally and may be used when nitroglycerin is not effective or causes significant side effects.

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 internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence.

Lifestyle and home remedies

Lifestyle modification may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences:

  • Increase fiber in diet.Eat approximately 30 grams of fiber a day to keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. Fiber supplement can also be used. Adding fiber may cause gas and bloating, so increase your intake gradually.
  • Drink adequate fluids.Fluids help prevent constipation.
  • Exercise regularly.Moderate exercise of 30 minutes or more, such as walking. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure.
  • Avoid straining.Straining creates pressure, which can open a healing tear or cause a new tear.

Homeopathic Treatment 

  1. Graphites- best medicine for anal fissure with burning

  2. Nitric Acid – best medicine for anal fissure with bleeding

  3. Ratanhia – best remedy for anal fissures with pain remaining long after stool

  4. Paeonia – best medicine for anal fissures with oozing

  5. Phosphorus – best homeopathic medicine for fissures that are painless

Unani Medicine Treatment :

The objective is to avoid constipation and straining and help the tear to heal naturally.

  • Grind 25 gm.Halaila siyah (Black variety) and 25 gm of Almond separately and add honey. The mixture may be taken twice a day. It is a useful remedy for it as well as piles.
  • 6 gm of Aspaghol along with milk may be taken daily at bed time to get relief.
  • 2 tablespoon of Itrifal Mulayyan is a valuable unani medicine that is recommended with warm water at bed time

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