It is also called as FISSURE IN ANO. An anal fissure is a small rip, tear or crack, in the lining of anal canal, a tear or cut in the anus extending to anal canal. Anal fissure are usually less than one centimeter, but anus is very sensitive part of body because of which pain in this area can be very severe, even with small rip or tear.
1) Pain: Pain is sharp while passing the stool followed by a longer deep burning sensation. Patient may avoid going to toilet, which may lead to increasing their risk of constipation. Patient delays going to bathroom resulting in making pain and tear the worst because stool will be harder and larger. Some patients also experience sharp pain while cleaning themselves with toilet paper.
2) Blood: Bright red blood because it is fresh bleeding on stool. Anal fissure in infants usually bleeds.
3) Itching: Itching in anal region is due to disturbance in mucosal lining of anus caused by tear. The sensation may be persistent or intermittent.
4) Dysuria: Patient may complaint of discomfort while urinating which is less common.
1) Constipation hard, large stools cause lesion in anal area during bowel movements than soft and smaller ones.
2) Diarrhea repeated diarrhea can cause anal fissure because of tear in anal lining.
3) Pregnancy and childbirth pregnant women are more prone to high risk of developing an anal fissure mainly towards the end of their pregnancy. During delivery or child birth anus may tear.
4) Muscle spasmanal sphincter muscle spasm may gets increase the chances of anal fissure. Spasm is automatic jerking muscle movement, when muscle can suddenly tighten. This spasm also undermines healing process.
5) Sexually-transmitted infections (STIs) also known as sexually transmitted diseases (STDs) - are always with high risk of anal fissures. Few examples syphilis, HIV.
6) Anal sex
7) Underlying conditions diseases such as ulcerative colitis, Crohn's disease and other type of inflammatory bowel diseases.
1) Failure to heal Anal fissure that has failed to heal within six week is considered as chronic and may further require treatment.
2) Recurrence once a patient experience anal fissure they are prone to it.
3) Tear that may extends to surrounding muscles.
Diagnosis is done by doctor after physical examination of anal area. Rectal exam with gloved finger or small instrument into rectum, cause tremendous pain or may be done with anesthesia to the area Colonoscopy or Sigmoidoscopy is a flexible or rigid viewing tube is used to inspect inside the rectum and anus.
Pain Topical anesthetic-topical means it is applied directly to the skin. For prolonged burning sensation after visiting toilet, Tylenol (acetaminophen) or ibuprofen may help to relief pain with doctor's guidance only. Topical nitroglycerin helps to speedy recovery of lesion by dilating the blood vessels in the area. Doctors recommend it when healing process is slow.
Calcium channel blockers It is mainly designed to bring down high blood pressure, it also helps to relax the muscle sphincter. Speedy recovery by increasing blood supply to affected area
A steroid ointment/cream this helps to reduce inflammation around the anal fissure lesion it will also help to reduce itching and pain.
Botulinum toxin (botox) for muscle spasm
1) Fissures which are long term (chronic fissure) and does not heal with medication then surgery is the option
2) Internal Sphincterotomy procedure- A portion of anal sphincter is removed surgically resulting in less severe spasms.
3) A fissurectomy procedure- surgical removal of the fissure- it is rare and may be used in children.
Homoeopathy enhances the entire process of digestion naturally, to get relief from constipation and straining from stools, which are main cause of anal fissure.
Graphites-(Anal fissure with burning pain) It is excellent remedy for anal fissure with constipation of large difficult stool. Burning, Smarting and sore are marked symptoms of remedy which is during and after passing stool. Patient is usually obese. Stool may be large knotty hard and joined by mucous threads. Patient is extremely chilly can't tolerate cold air and weather. Anal fissure in women occur around menopause. There may be skin symptom like eczema with characterized by oozing of thick sticky fluid.
Nitric acid (Anal fissure with bleeding after stool)It is best remedy for bleeding (bright red color) during and after stool, where the pain of the patient is violent splinter like sensation (or stick in anal) in anal region with offensive discharge. The offensiveness of discharges may even with urine, stool and perspiration. Patient is chilly. Stool is soft even though patient has to strain to pass the stool. Speedy recovery by increasing blood supply to affected area
Silicea (fissure in anal in female patient just before and after menses) Patient complains of having a very specific type of constipation where stools are partly expelled out from anus, and partly stools will recede back into anus. Silicea is strongly recommended remedy for fissure in anus in female patients who complain of constipation always before and during menses. Straining leads to fissure in anal region.
Ratanhia (pain sensation as if anus is full of broken glass) One of the best remedy for anal fissure when burning is felt in anus for prolonged hours after passing stool. Patient describe pain is as if full broken glass is there in anus, alternately a sudden stitching type of pain is felt as if knife is being piercing inside anus this is the marked symptom of remedy. Ratanhia is recommended when burning pain is temporarily better by cold water.
Paeonia (fissure in ano with itching and oozes offensive discharge) Remedy most recommended for anal fissure that cause itching and oozes offensive discharge. It is very good remedy for the same. Ulceration in anal and perianal region. There is excruciating pain felt in anus during and after passage of stools for many hours.