Anal Fissure is Common Cause of Visit to Our Proctologist at Colorectal Clinic Vashi, Navi Mumbai. Fissure in Ano is a tear or cut in the linings of anus.
Fissures typically cause severe pain and bleeding while passing stool (faeces) and often confused with haemorrhoids or cancer. Delay in diagnosis causes acute fissure becoming chronic and thus more difficult to treat.
Majority of anal fissure does not require surgery; surgery is advised if home care and medical treatment (read below) fails.
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Causes of Anal Fissure
- Most common cause is trauma to anus while passing stool in constipation or repeated diarrhoea.
- Occasionally rectal thermometer, endoscope, enema tip can be the reason of trauma
- Other rare causes: crohn’s disease, anal cancer, tuberculosis, viral infections (syphilis, herpes, cytomegalovirus, HIV) Biopsies of these fissures are mandatory.
Symptoms & Diagnosis of Anal Fissure
- Severe Pain at anal area that worsens on bowel movement
- Bleeding while passing stool (more common in infants)
- Anal Itching
Careful history of pain and bleeding while passing stool, usually suggests presence of anal fissure. Visible fissure in the midline of anus confirms diagnosis.
If rectal bleeding is present rigid or flexible sigmoidoscopy is usually done at our one stop colorectal clinic at Vashi, Navi Mumbai. In a patient over 50 years of age or with a family history of colon cancer a colonoscopy is to be performed.
Home & Medical Treatment of Anal Fissure
An acute fissure is typically managed with non-operative treatments and over 90% will heal without surgery. Often treating constipation or diarrhea can cure a fissure.
General Treatment and Home Remedies for Anal Fissure –
- Drinking plenty of water (8-10 glasses)
- High fibre diet
- Over the counter fibre supplements (25-35 grams of fibre per day)
- Avoiding food that may not be digested easily like -nuts, popcorn
- regular exercise
- Use of moist tissues or shower spray is often better alternative to toilet paper after bowel movements.
- hot sitz both -(sitting in a tub of Luke warm water for 20 min)
Medical Treatment for Anal Fissure –
- Stool softener containing (natural psyllium husk)
- Topical/local anaesthetic gel to reduce pain
- Topical ointment for relaxation of sphincter, headache is a side effect.
- Topical Ca channel blockers are effective alternative in breast feeding women where should not be used.
Injection & LASER For Anal Fissure
- Treatment works by temporary paralysing muscles of internal sphincter. Toxin injection into internal anal sphincter is effective and and it can berepeated.
- LASER treatment for anal fissure
Anal Fissure Surgery in Mumbai
Surgery is indicated when medical management and life style modification fails to heal an anal fissure. Chronic fissure present for more than 6 weeks may require a biopsy to rule our crohns or cancer.
Dr Nitish Jhawar- General, laparoscopic and colorectal surgeon with 17 years extensive experience in the field has fellowship of Association of Colorectal Surgeons of India (FACRSI) and Fellowship in colorectal surgeries from U.S.
He offers Lateral internal sphincterotomy, flaps surgery and LASER treatment for Anal Fissure.
Lateral Internal sphinterotomy –
Standard Task Force of the American Society of Colon and Rectal Surgeons has recommended partial lateral internal sphincterotomy as the technique of choice for the anal fissures surgery.
In this procedure less than a third of sphincter is cut at the level of fissure. It is extremely effective procedure. If a sentinel pile is present, it may be removed to promote healing of the fissure.
Anoderm or rectal advancement flaps – if fissure does not heal by any means, than ANAL FISSURE is removed and repaired using a flap. This is particularly done for chronic painless fissures where spam is not the cause.
Recovery & Preventing recurrence
Recovery after Anal fissure surgery
Complete healing with medicines or surgical treatments can take up to approximately 6-10 weeks. However, patient is relieved of acute pain after surgery within a few days. Majority of patients can resume work and daily activities in a few days.
Preventing recurrence of Anal fissure:
- Avoid constipation by drinking plenty of water and high fiber diet
- Avoid supressing natural urge to pass stool
- Develop regular bowel habit
- Avoid straining at stool
- Avoid anal intercourse
Can fissure cause colon cancer?
No, fissure cannot lead to colon cancer, however careful evaluation and proper diagnosis by colorectal surgeon is required as other conditions can cause similar symptoms as anal fissure.