Fissures

What are Fissures

Anal fissure or Fissure-in -Ano is nothing but a crack/injury in the soft and delicate lining of the anal canal. They are mostly commonly a result of passing a hard stool.
These can happen at any age and in both the sexes.

They have been classified as
1. Acute – early , less than a month +/- 15 days
2. Chronic – long standing, more than 2 months duration. Mostly have a skin covering like piles

This classification is very useful as most all Acute fissures can be treated without operation and surgery while most chronic fissure’s need some kind of surgical intervention.
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Causes & Symptoms

Causes:
  • Constipation- the cause in most cases. Hard stools causes the injury while passing.
  • Frequent bowel movements can cause the delicate anal lining to tear
  • Rare causes of anal fissure are inflammatory bowel diseases like Crohn’s disease, tuberculosis, etc.
Symptoms:
  • Pain : The pain in anal fissure during defecation is worse. Infact people tend to eat less so as to avoid going to toilets. The pain experienced is tremendous and can be a tearing type.
  • Burning : Post defecation , usually there is sever burning sensation in the bottom’s which may last from few minutes to hours or be there whole time.
  • Bleeding : There may be blood on the stools or it may occur after the motion has been passed.
  • Constipation : More often than not , fissure patients are constipated , adding to this is their tendency to avoid motions which further complicates things.
  • Swelling : One may simple feel a swelling in the bottom’s or one can feel a small swelling while washing the bottom’s.
  • Itching : These can be from mild to severe making a very embarrassing scene of scratching the bottom on and off.
A simple examination by a Colo-Rectal specialist will suffice in diagnosing this.

Treatments for Fissures

Most Fissure's can be treated conservatively , atleast the acute one's. Most of the chronic fissure's need some surgical treatment in the form of an operation. Dilatation : Forceful opening of the anal canal which is under spasm, done under anaesthesia. These lead to loss of bowel control in most cases due to damage to the anal sphinctor's/valves. Hence largely abandoned or done by people not abreast with the newer method's.

Lateral Internal Sphincterotomy : Achieves the same principle of releasing the anal spasm but where a small muscle is incised . Need to be done by expert's as the degree of incised muscle directly correlates with the bowel control.

Advanced Treatments Most of the treatments are painless and bloodless. In many cases, patients can be discharged in 1 day. The chronic fissure which fail to respond to conservative treatment are dealt with Laser Lateral Internal Sphincterotomy (Laser-LIS) which is the least invasive and highly effective , thus according the patient full control over his bowel movements.