What is an anal fissure?
It is a painful crack in the internal lining of anus. This
condition is common in all age groups. It is not a cancer.
How is it caused?
In patients who have constipation hard stools may tear the
internal lining and cause an anal fissure. Some of these are
associated with childbirth. Rarely, it is because of another
illness such as tuberculosis or a type of inflammatory bowel
disease known as Crohn's disease.
What are the symptoms?
Passing stool is very painful and this pain may persist.
Occasionally there is bright red bleeding that may stain the stool
or come in drops.
How is this condition treated?
Some fissures get better without any special treatment. However,
most require treatment, as it is a very painful condition.
1. Steroid ointments, painkillers, local anaesthetic creams and
warm baths relieve pain but do not help in healing.
2. Nitroglycerin (0.2%) applied locally twice daily every day for
6 weeks will cure about 70% of these fissures. This ointment is
very difficult to obtain in India. The side effects of this
ointment application include troublesome headaches and even
faintness.
3. Quick healing can be achieved by partially dividing the anal
sphincteric muscle, but this requires an operation.
4. Anal dilatation is a rather crude method of overcoming spasm of
the anal sphincter and this may result in complete damage to the
sphincter especially in women.
When is an operation necessary?
If the fissure does not get better on its own and there is a lot
of pain, it is advisable to have an operation called lateral
internal sphincterotomy.
In this operation, the surgeon examines the patient under
anaesthesia, may take a biopsy if he thinks it is necessary and
cuts the anal sphincter partially. Often, a portion of skin that
sits just below the fissure called sentinel pile is also removed.
Once the sphincter is divided, pain relief is instantaneous and
the fissure heals rapidly as the blood flow to that area
increases.
What are the problems associated with it?
After this operation minor leakage of stool for a variable length
of time may occur. The ability to distinguish between wind and
stool may be lost temporarily. There is complete recovery in
almost all the cases.
How can fissure development be prevented?
The best way to avoid an anal fissure is to avoid constipation
which can be done by taking a diet rich in dietary fibre which
includes fruits, green leafy vegetables, wheat flour (atta) and
the like.
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