What is an Anal Fissure?
An Anal Fissure is a condition where there is a small cut or breach in the lining of the epithelium of the anus. Anal Fissure is also referred to as Fissure in Ano. The mucosal layer lining the anal canal gets cut mostly due to an injury caused by constipated hard stool. Anal Fissure is comparable to mouth fissures. Since the anal region is rich in nerve and blood supply the cut is very painful.
Common Symptoms of Anal Fissure
- The passing of stool is accompanied by severe pain. The pain can also be during the rest.
- Bleeding along with bloody stools. Streaks of blood can be found in the stool either at the beginning of the motion or at the end when passing the motion.
- Deep burning sensation during defecation.
- A Visible tear in the anal region sometimes.
- Itching in the anal region as the cut or breach begins to heal.
What are the causes of Anal Fissure?
- The most common cause for anal fissures is constipation where hard stool is passed often. Patients with constipation are more susceptible to get anal fissures especially when they pass large-sized hard faecal matter.
- Sometimes certain medications may also cause constipation which can in turn cause fissure.
- Prolonged sitting can also cause anal fissure when the tip of the tailbone can disturb the anal lining. The friction and the last vertebral bone can irritate the sphincter and can cause an anal fissure.
- Women can get anal fissure during pregnancy and labor.
Some of the lesser known causes of anal fissure are
- Chronic Diarrhoea
- Ulcerative Colitis
- Crohn’s disease
- Idiopathic reasons
- PCOD and Chocalate cysts of ovary
Who are at risk of getting Anal Fissure?
An anal fissure can affect both men and women of any age. Studies show that 1 in every 10 people suffer from anal fissure. Generally, people above 40 years of age are more prone to constipation and hence the chances of them getting anal fissure are higher. However, kids and young adults between the ages 10-30 years of age are also prone to get anal fissure.
What are the complications of Anal Fissure?
- The pain caused due to the fissure may discourage people to defecate often or more precisely induce a fear to defecate. This fear aggravates the already present constipation. This may eventually lead to chronic constipation and in the worst case, faecal impaction.
- Some people might avoid passing motion and hence they might limit the intake of food or take liquid food.
- Sometimes, an anal fissure may also extend into the muscular region, or the anal sphincter of the anus, which can cause further discomfort. This can cause sphincter spasm. The sphincter spasm narrows the passage and as a result, can cause motion to be pushed hard. This can also cause the fissure to come back. When straining too much to pass the motion, the fissure opens and causes bleeding once again. If left untreated, reoccurrence of anal fissures can also be seen.
- If anal fissure does not heal within 6-8 weeks it may become a chronic anal fissure and may require surgical intervention.
Diagnosis of Anal Fissures
Diagnosis of Anal fissures include
- In the normal course, the colorectal surgeon does a digital physical examination of the anal region. In most cases, this is sufficient for the surgeon to understand the nature of the anal fissure.
- In some cases, the surgeon may want to ascertain the depth of the fissure if it has become chronic and hence the surgeon may call for an proctoscopy.
What are the non-surgical treatments for Anal Fissure?
In a majority of cases, only non-surgical treatment for anal fissures is recommended by the Gi Endo Surgeon. They include
- A controlled diet that is aimed at avoiding constipation in the first place. Including a liberal amount of fibrous food and increasing the water intake can help control constipation.
- Weight control or reduction
- Avoid sitting for long hours can also provide some relief. Commercially available piles seat can help to some relief if your job requires prolonged sitting or prolonged travel.
- Avoid tighter clothing.
- Stool softeners or laxatives can help to some extent.
- Medications to relieve any related muscular spasms.
- Sitz bath.
What are the surgical treatments for Anal Fissures?
Surgical treatment is not usually recommended in the initial stages. But sometimes anal fissure can come back again and again only to disturb our day to day routine. If it happens so, surgery for anal fissure is recommended as a last resort if all the other treatment options have failed.
In the surgical treatment, basically the sphincter is dilated, and the anal fissure is allowed to heal. The dilation relaxes the anus, makes the fissure not to appear and makes stool passing smoother. In severe anal fissures, the surgical treatment adopted is Lateral Internal Sphincterotomy or LIS. This approach is adopted if the internal anal sphincter is under tension and prevents the anal fissures to heal. In the LIS procedure, a small incision is made in the internal anal sphincter. This helps to release the tension in the internal anal sphincter.