Fissure in ano

Fissure in ano

DIGESTIVE DISORDERS- Fissure in ano

A fissure literally means a cleft / linear tear / opening / crack. Medically, fissure refers to linear crack in the skin. Skin cracks can arise anywhere in the body. But the cracks are most commonly seen in edges or at the junction of two different types of skins, for example rim of heel, corners of mouth, lips, anus, nipple, webs of fingers, ear folds, etc. The commonest of these is cracks in heels followed by fissure in anus. Fissure in ano is a most painful condition of all anal complaints.

Pathophysiology – Anus is a muscular canal made of internal and external sphincter muscles. Its elasticity and ability to contract takes total control in controlling and evacuating the faeces. The bulkness or hardness or dryness of stool can stretch the anus while evacuating and can cause a tear. Once the anal skin is torn, every stool urge will be a fearful and painful event.

Fissure in the anus is a linear cut wound which occurs mostly superficial and involves only the epidermis in the start-up. But, when left uncared-for or if it becomes chronic or if it gets more strained after having superficial fissure, it usually gets deepened and involves the dermis also and becomes more painful. The painful nature makes the anus to contract to avoid pain and for natural healing. But, the faeces having no other way to pass out stretches the fissure more and hinder the curing process. The tear will usually cause bleeding which can be noted as streaks in the passed stool. Usually, the blood will be fresh and scanty. But sometimes it may come in gushes, colouring the total pan making the sufferer panic.

Anal fissure is usually about 1-1½ cm and is present as a raised triangular area in the lip of the anus. The lower end of the triangle lies in the edge where as the upper part of the triangle lies deep inside the anus. In the lower end of the raised triangular area, a skin tag or swelling will be usually present. This tag / knot is nature’s protection which occurs to guard the extending tear in the bums. Since it guards the extending fissure, it is named as sentinal pile. This sentinal pile is often misunderstood as pile mass and many of the patients will take treatment of their own or tell the doctor about the pile mass. Anal fissures usually recur in people who tend to be constipated often.

Incidence – Fissure is supposed to be common in constipated people (ones who pass bulky, hard and dry stool) with the habit of suppressing the stool urge. Fissure can occur at any age when you get constipated i.e. even children / infants can have fissure. Babies cry while they defecate due to the pain in case of fissure. But mostly it gets resolved on its own if diet is taken care of. Anal fissure can also be found to coexist with piles, since the scarred or thrombosed area of the pile is supposed to get cracks or fissures. Fissure is mostly present in midline, either in the front or back. Males suffer from fissures mostly in the back end of the anus, whereas females suffer in the front part which are the weak points for men and women.

Causes – The major causes are supposed to be,

• Physical strain -Pressure exerted while passing stool
• Defecation – Anal fissure is most commonly caused by constipation. The hard, dry stool tears the anus when it stretches the anus forcibly while defecating. It can also be caused by diarrhoea due to sudden purge or straining after enema.
• Foods – Low fibre diet, more spices, alcohol and lesser intake of water can produce hard dry stool, which needs more strain in defecation
• Weakened anus sphincter muscles – due to any diseases or trauma etc
• Dry skin disorders which affect lower part of anus
• Small tight anus – congenitally small or spastic tight anus

Symptoms

• Cruel pain is the major symptom of fissure – Pain may be burning, stabbing, pricking and a feeling of glass pieces or thorns in the anus. Pain is usually aggravated after defecation. The patients used to suffer with pain for more than half-an-hour after passing stool or for the remaining whole day.
• Bleeding usually occurs at the time of defecation which appears as a streak in the stool. Usually it will be fresh and is supposed to come in drops after defecation but neverpasses mixed with the faeces.
• Tightness or spasms of the anus usually interrupt in passing the stool
• The fissure is always visible / felt as a swollen traingular (thickened) area with the skin tag in its lower end
• With the fear of pain, patients usually avoid the act of defecation and develop constipation from there which further worsens the condition

Diagnosis – of fissures is easy, since a simple examination with slight stretch of anus can identify the fissure. Digital examination will be very painful in all the case of fissures due to spasm and tightness of anal sphincters, so it is avoided mostly.

Management – Many fissures can be healed with simple management as follows.

• Take plenty of water and fruit juices
• Avoid non-veg and fatty diet
• Take easily digestible, simple food with plenty of vegetables
• Use Indian style toilets since squatting position will be a better position for pain and natural defecation.
• Follow hygienic measures in cleaning and caring
• Pass stool twice a day to avoid dry hard stool and strain to rectum and anus
• Never suppress an urge. Go for stool whenever there is a call since it will be easy then
• Don’t strain to evacuate hard faecal matter. Take time in the toilet for a natural descend with relaxed anus. It is better to have semi-solid stool for easy defecation
• Sitz bath – Before passing stool, sit in a shallow bath tub of warm salt water for 10 – 15 minutes to relax the anal sphincter and to relieve the anal spasm. This technique usually pacifies all the painful anal conditions

For better healing
Avoid

• Sporting activities, long-distance walking / travelling / cycling during healing process
• Any friction or injury
• Dry cleaning by toilet papers. Go for wash with warm water which usually soothes
• Scratching, since it may become red, sore and infected.
• Non-veg, fast foods, oily foods, etc.
• Spices and chillies
• Smoking, drinking alcohol and coffee

Take

• Rest
• Vitamin E and zinc supplementation for better healing.

Prevention – It is well said that prevention is better than cure. Always follow these procedures to avoid anal sufferings

• Take plenty of water for easy defecation and to avoid constipation.
• Follow regular bowel habits
• Take hygeinic measure to keep anus clean and dry
• Treat constipation or diarrhoea immediately

General treatment – Superficial fissures usually heal well with simple management and conservative treatment within two weeks. But most fissures are left untreated and so get complicated. The excruciatingly painful fissures often compels the sufferer to opt for treatment. Allopathy usually provides ointments for healing and pain relief. External applications like germicidal or bactericidal or antiseptic or anaesthetic agents or moisturisers or steroid ointments are the common referral list from the doctor’s desk. Internal medicines are mostly avoided, but in case of extreme painful deep fissures, antibiotics are used to control the infection with pain killers. Some will go for anal dilatation, some others will make the stool loosen. But unless anal fissures are cared for properly with diet and habit, no one can get rid of it permanently.

Surgery – Mostly anal fissure heals without surgery, if it is cared for in its initial days itself. But if it becomes chronic and persistent, then, as a last resort, surgery can be opted. Surgical procedures usually make a linear cut in the spastic anal sphincter muscles to give more way for the faeces, so that faeces can be passed out in a relaxed manner without giving any stretch to the fissure. Then fissure is treated with antibiotic and ointments for easy healing. But, even after surgery, one should be aware of recurrences and should be very careful, particularly in avoiding constipation and strain or otherwise fissure will be back. The complications of surgery may include loss of control in passing flatus (air) and stool urge. Sometimes there may be slight leakage / oozing of faecal matter due to relaxed anus after operation.

Homeopathic approach – Fissure should be treated as early as possible or otherwise it would become chronic fissure which will resist cure. Like in any cut wound, in fissure also, delay in healing makes the fissure lips thicken, which resist the curing process also with its tendency of recurrence. The main reasons for recurrences are

• Though a fissure is well healed after medication or by its own, it will be a weak point which cannot be stretched as before. So, any strain at defecation can cause fissure again.
• The wound usually heals with scar which lacks elasticity of the skin, so any stretch may lead to tear again.
• Rest cannot be offered to anus since it has to expand and contract during every act of defecation and has friction from faeces.
• Constipation
• After having fissure, the anus usually remains contracted than before, for two reasons
  1. Natural aiding for close approximation to have better healing
  2. Stretch will cause pain, so it remains in a contracted stage to avoid pain.

In fact, Homoeopathy, unlike other systems of medicine, doesn’t concentrate on just healing the spot, it cares for a whole lot of other things i.e. it strengthens the affected part with more blood supply, heals the wound in a better way, aborts the tendency to constipation, relaxes and relieves the spasm of anus with better wound healing, etc. So recurrences will be well controlled or avoided with Homeopathy.

Homeopathy can do wonders when one opts for the treatment in case of fissure. Also, surgery cannot cure all cases of fissure. Even after surgery it can recur if the root cause is not cured. So, Homeopathy treatment is the best way to root out the disease and cure fissure in ano without any side-effects.

Homeopathic medicines commonly used in case of fissure are -Acid Nit, Bryonia, Calc Flour, Calc Sulf, Causticum, Capsicum, Carboveg, Collinsonia, Graphites, Hamemelis, Hepasulf, Hydrastis, Hypericum, Lachesis, Lycopodium, Mag Phos, Merc sol, Muriatic acid, Ratahnia, Silicea, Sulphur, Thuja, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

 

(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)