What is Fistulas and Fissures?
An anal fissure is caused by a small tear in the thin, moist tissue (mucosa) that lines the anus. Fissure might emerge when you pass hard or large faeces during a bowel movement. fissures are characterized by pain and bleeding in bowel movements. It’s also possible to have spasms in the muscular ring at the end of your anus(sphincter).
Fissures are especially frequent in newborns, although they can afflict anyone. Simple therapies, such as increased fibre intake or sitz baths, help most fissures heal. Fissures may require medicine or, on rare occasions, surgery.
The following are signs & symptoms of an fissure:
- Pain, sometimes severe, during bowel movements;
- Pain that can continue for several hours following bowel movements;
- Bright red blood on the stool after a bowel movement.
- The skin around the anus has a visible crack.
- A tiny lump or skin tag at the anal fissure on the skin.
When to see a doctor
See your doctor if you have pain during bowel movements or detect blood on your stools or toilet paper after a bowel movement.
Causes
The following are common causes of fissure:
- Large or firm stools passing
- Constipation and bowel motions that strain
- Consistent diarrhoea
- Anal interaction
- Childbirth
- A variety of things can cause fissures.
- Irritable bowel disease, such as Crohn’s disease.
- Anal carcinoma
- HIV
- Tuberculosis
- Syphilis
Risk elements
Anal fissures can be caused by a variety of factors, including:
- Constipation. When you strain during bowel movements or pass firm stools, you are more susceptible to tears.
- Childbirth.
- After having delivery, women are more likely to develop fissures.
- Crohn’s disease is an inflammatory bowel disease that lasts for years.
- Chronic intestinal inflammation results from this inflammatory bowel disease, making the anal canal lining vulnerable to tears.
- Anal intercourse.
- Age.
- Fissures affect people of any age, but they are more common in infants and middle-aged individuals.
Complications
Fissure complications might include:
- Inability to heal.
- A persistent fissure does not heal within eight weeks and may require additional treatment.
- Recurrence.
- You’re more likely to get another if you’ve had an fissure before.
- A rip that extends to the muscles around it.
- An fissure that extends into the muscle ring that keeps your anus closed (internal anal sphincter) can make healing your fissure more challenging. An unhealed fissure can set off a vicious cycle of agony that may necessitate drugs or surgery to relieve the pain and repair or remove the fissure.
In context of Nepal
According to one survey done in Karnali Academy of Health science, the prevalence of anal fissure is highest in patients with anorectal complaints, with a little female predominance. The majority of the cases were found to affect adolescents. The female gender should always be considered carefully in the outpatient department when diagnosing fissure patients with anorectal problems, especially during the winter season.
Prevention
By avoiding constipation or diarrhoea, you may be able to avoid developing an fissure. To prevent strain during bowel motions, eat high-fibre foods, drink plenty of water, and exercise often.
Diagnosis
The doctor will probably inquire about your medical history and do a physical examination, including a mild exam of the region. The tear is frequently noticeable. An fissure is usually diagnosed with just this exam.
Acute fissures resemble a fresh tear, similar to a paper cut. A chronic fissure is more likely to have a deeper tear and fleshy growths on the inside or outside. If a fissure lasts longer than eight weeks, it is labelled chronic.
The location of the fissure provides information regarding its cause. A fissure on the side of the anal orifice, rather than the rear or front, is more likely to indicate the presence of another ailment, such as Crohn’s disease. If your doctor suspects an underlying issue, they may suggest more testing:
Anoscopy
An anoscope is a tube put into the anus that allows your doctor to see the rectum and anus.
Sigmoidoscopy with flexibility
A thin, flexible tube with a tiny camera will be inserted into the bottom region of your colon by your doctor. You may be eligible for this test if you’re under 50 and have no risk factors for intestinal disease or colon cancer.
Colonoscopy
Your doctor will place a flexible tube into your rectum to evaluate your entire colon. This test may be recommended if you’re over 50 and have risk factors for colon cancer, evidence of other illnesses, or other symptoms, including abdominal pain or diarrhoea.
Treatment
Fissures heal in a few weeks if care is taken to keep the faeces soft, such as increasing fibre and hydration intake. Soaking in lukewarm water for 10 to 20 minutes a day, particularly after bowel movements, might help relax the sphincter and promote healing.
If your symptoms persist, you will almost certainly require more treatment.
Nonsurgical options
Your doctor might suggest:
- Nitroglycerin is given externally to aid enhance blood flow to the fissure, promote healing, and relax the anal sphincter. When other conservative treatments fail, nitroglycerin is generally the medical therapy of choice. An intense headache is one of the possible side effects.
- Lidocaine hydrochloride (Xylocaine) is a topical anaesthetic cream that can help with pain relief.
- Botulinum toxin types A (Botox) injection for spasms relaxation and paralyses the sphincter muscle.
- Oral nifedipine (Procardia) and diltiazem (Cardizem) are blood pressure drugs that can help relax the sphincter. These drugs can be taken orally or used topically, and they can be utilised when nitroglycerin isn’t working or causes remarkable side effects.
Surgery
If one has a chronic fissure that hasn’t responded to other treatments or if your symptoms are severe, your doctor may recommend surgery. Cutting a tiny section of the sphincter muscle to reduce spasms and facilitate recovery is known as LIS (lateral internal sphincterotomy).
Studies show that surgery is considerably more effective than medication in treating persistent fissures. However, there is a potential that the procedure will cause incontinence.
Ayurvedic Management:
In Nepal, the Ayurvedic application of ksharsutra and kshar karma efficiently reduces the fissure pain and complaints. There are many ayurvedic hospitals that see the cases of Anal fissure and treatment like Naradevi Ayurveda Hospital.
Source
Menyangbo, Suryaman & Bhatta, Gakul & Subedi, Kripa. (2020). Prevalence and Seasonal Pattern of Fissure in Rural Hospital of Nepal. Journal of KIST Medical College. 2. 10.3126/jkistmc.v2i2.33577.
https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424