What is Fissure-in-Ano (anal fissures)?

Fissure-in-Ano

Anal fissures is a tear in the thin tissue that lines the anus. Anal fissures can occur at any age, but are more common in infants and middle aged adults. Constipation – Straining at stools during bowel movement and passing hard stools increases the risk of tearing of the anal mucosa.

Symptoms

  • Pain, sometimes severe during bowel movements.
  • Pain after bowel movements that can last up to several hours.
  • Bright red blood on the stool or toilet paper after a bowel movement.
  • A visible crack or tear in the skin around the anus.
  • A small lump or skin tag on the skin near the anal fissure.
anal fissure

When to consult your Doctor?

  • If you have pain during bowel movements.
  • Notice blood on the stools or toilet paper after a bowel movement.

Diagnosis

A fissure can be diagnosed by visual inspection of the anus or by gentle exam with the tip of the finger.

Prevention

  • Prevent constipation—Eat high-fiber foods, drink adequate water and exercise to keep from
  • Straining during bowel movements. 
  • Avoid straining or prolonged sitting on the toilet.
  • Cleansing the anorectal area more gently. Keep the anorectal area dry. Wipe the area with soft materials, avoid rough and scented toilet paper.
  • In infants change diapers more frequently and treat constipation (if that is determined to be the cause).

Treatment

The goal of treatment is to lower the pressure on the anal cavity by making the stools soft as well as easing discomfort and bleeding.  Conservative treatments are tried first and and include one or more of the following:

Explaining to the patient the necessity to follow the principles of prevention.

  • Use of stool softners.
  • Increase in intake of high fiber foods and fiber supplements.
  • Soak in a warm bath(also called a Sitz bath) for 10 to 20 minutes twice daily to promote the relaxation of the anal muscles.
  • If these measures fail, SURGERY is contemplated.

Conservative management usually fails due to scarring and 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, thereby   decreasing the spasm in the muscle allowing the fissure to heal.

Complications

  • Failure to heal—An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment.
  • Recurrence—Once you’ve experienced an anal fissure there is a possibility that you are prone to having another one.
  • A tear can extends to the surrounding muscle into the ring of muscle that holds the anus closed making it more difficult for the anal fissure to heal.  This causes a cycle of discomfort and pain.

At Hande Hospital we routinely treat Fissure in Ano with Laser. This has several advantages. Unlike conventional surgery there is no cut or suture. Post operative pain is substantially less. The procedure is a Day Care procedure and the patient can get back to work in a day or two. 

Often the patient suffers from both Fissure and Piles and both these conditions can be treated effectively with Laser.

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