About Anal Fissure
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About Anal Fissure

What is Fissure In Ano?

An anal fissure (also called fissure-in-ano) is a small rip or tear in the long axis of the lower anal canal. It is one of the most painful conditions resulting in a lot of discomfort and embarrassment to the patient.

Causes

What causes an anal fissure?

Anal fissures can be caused by trauma to the anus and anal canal. The trauma can be caused by one or more of the following:

• • Chronic (long-term) constipation
• • Straining to have a bowel movement, especially if the stool is large, hard and/or dry
• • Prolonged diarrhea
• • Anal sex, anal stretching
• • Insertion of foreign objects into the anus

Causes other than trauma include:

• • Longstanding poor bowel habits
• • Overly tight or spastic anal sphincter muscles (muscles that control the closing of the anus)
• • An underlying medical problem, such as Crohn's disease and ulcerative colitis (types of inflammatory bowel disease); anal cancer; leukemia; infectious diseases (such as tuberculosis); and sexually transmitted diseases (such as syphilis, gonorrhea, Chlamydia, chancroid, HIV)
• • Decreased blood flow to the anorectal area

Anal fissures are also common in young infants and in women after childbirth. If a fissure does not improve with treatment, it is important to be evaluated for other possible conditions.

Symptoms

What are the signs and symptoms of an anal fissure?

Anal fissures typically cause a sharp pain that starts with the passage of stool. This pain may last several minutes to a few hours. As a result, many patients may try not to have bowel movements to prevent pain.
Other symptoms include:

• • Constipation
• • Blood on the outside surface of the stool
• • Blood on toilet tissue or wipes
• • A visible crack or tear in the anus or anal canal
• • A small lump or skin tag close to the anal fissure
• • Burning and itching that may be painful
• • Foul-smelling discharge

Feel free to consult Dr. Brijendra Singh at Brij Laser and Laparoscopy Centre if you notice any of these symptoms.

Diagnosis

How is an anal fissure diagnosed?

Usually, doctor can diagnose an anal fissure by visual inspection of the anus or by gentle exam with the tip of the finger.

Treatments

How are anal fissures treated?

The principle of anal fissure treatment is to lower the pressure on the anal canal by making stools soft, and to ease discomfort and bleeding. Conservative treatments are tried first and include one or more of the following:

• • A high-fiber diet and over-the-counter fiber supplements (25-35 grams of fiber/day) to make stools soft, formed, and bulky.
• • Over-the-counter stool softeners to make stools easier to pass.
• • Soaking in a warm bath (also called a sitz bath), 10 to 20 minutes several times a day, to help relax the anal muscles.
• • Cleansing the anorectal area more gently.
• • Avoiding straining or prolonged sitting on the toilet.
• • Medications, such as lidocaine, that can be applied to the skin around the anus for pain relief.
• • Narcotic pain medications are avoided because they can cause constipation which could make the situation worse.

Surgical Treatment

Although 80%-90% of anal fissures do not require surgery, chronic fissures are harder to treat medically and anal fissures persist or come back. In this condition surgery may be the best option. The goal of surgery is to help the anal sphincter muscle relax which reduces pain and spasms, allowing the fissure to heal. Surgical options include

A. Botulinum toxin type A (Botox®) injection into the anal sphincter. The injection temporarily paralyzes the anal sphincter muscle, relieving pain and promoting healing. Botox® injections are associated with healing of chronic anal fissures in 50% to 80% of patients.

B. Surgical division of an inner part of the anal sphincter (lateral internal sphincterotomy). Sphincterotomy is successful in more than 90% of patients.

C. Advancement Mucosal Flap Sometimes, long-standing chronic fissures do not heal, even with an adequate sphincterotomy, and an advancement flap is performed in that case to cover the defect in the mucosa. This can be performed either at the time of the sphincterotomy if the surgeon does not think that the fissure will heal, or as a second procedure if the fissure does not heal.

D. Anal Dilation (Lord’s Operation) Lord’s Operation, or stretching of the anal canal, is an older method of treating fissures. It has fallen out of favor in recent years, primarily due to an unacceptably high incidence of fecal incontinence. In addition, anal stretching can increase the rate of flatus incontinence. Hence we at Brij Laser and Laparoscopy Centre never recommend this as treatment for anal fissure.

Dr. Brijendra Singh at Brij Laser and Laparoscopy Centre educate patients on all the available treatment methods so they can make informed decisions about their own health. With years of education, training and research he knows which procedures offer the best results. This is why it is crucial to meet Dr.Brijendra Singh, a colorectal expert, in person to discuss your surgical options for treating anal fissures.

Advanced Technology Which We Follow

What does Laser surgery for an anal fissure involve?
A fissure may fail to heal because of scarring or muscle spasms of the internal anal sphincter muscle. Surgery usually consists of making a cut to a small portion of the internal anal sphincter muscle with the help of Laser beam to reduce pain and spasms and allow the fissure to heal. The surgery can usually be performed on an outpatient basis (the patient goes home the same day). Procedure is painless or you may feel very little pain after the surgery and complete healing of fissure may happen with in weeks period.

Why Painless Laser Treatment for anal fissure?

• • No Cuts & No Stitches
• • Painless
• • 25 Min Procedure
• • Discharge on the same day
• • Join work in 48 Hours

Don't Delay Laser Treatment for anal fissure in following conditions because it can be cured in a single day

• • Extreme Burning Pain While Sitting
• • Bleeding in Stool