What Is An Anorectal Fissure
Anorectal fissure is a very common and painful condition. This condition is characterized by a longitudinal crack in the skin of anus. If the skin lining of the lower end of the anus gets scratched, it may break up into a fissure. Fissures most commonly occur in the midline posteriorly, the least protected part of the anal canal. In males fissures usually occur in the midline posteriorly (90%) and much less common anteriorly (10%). In females fissures on the midline posteriorly are commoner than anteriorly (60:40).
Causes Of Anorectal Fissure
- Most Common Cause Of The Fissure In Ano Is CONSTIPATION. Chronic Constipation Due To Any Reason (Such As Habitual, Drug Induced, Pregnancy And So On) Leads To Recurring Abrasion Or Forceful Rubbing Of The Anal Mucosa, Which Leads To A Fissure.
- Spasm Of The Internal Sphincter Has Also Been Incriminated To Cause Anal Fissure.
- When Too Much Skin Has Been Removed During Operation For Hemorrhoids (Piles), Anal Stenosis May Result In Which Anal Fissure May Develop When Hard Stool Passes Through Such Stricture.
The other less common causes are :
- Following Bout Of Diarrhea Or Following Passage Of Bulky Stools Very Quickly (Especially In Children).
- Multiple Pregnancies.
- Chronic Use Of Laxatives.
- Rarely, A Fissure May Be The Manifestation Of Underlying Disease Like Crohn's Disease, Ulcerative Colitis, Sexually Transmitted Diseases, Cancer And So On.
- Surgery For Piles (Hemorrhoids) Done Imperfectly.
Symptoms Of Anorectal Fissure
- Pain While Defecation: The Lower Anal Canal Is Extremely Sensitive Area Of Skin And Can Produce Fairly Significant Signals Of Pain If Damaged. Sharp Agonizing Knife-Like Pain Starts When The Individual Passes Stool. The Pain Is Severe And Persists For An Hour Or So. It Ceases Suddenly. After The Pain Goes Off The Sufferer Remains Comfortable Till The Next Action Of The Bowels. The Individual Tends To Be Constipated Rather Then Go Through Painful Ordeal. If A Fissure Becomes Chronic And Deep, Dull Aching Kind Of Pain Develops That Starts A Few Minutes After The Bowel Movement And Can Persist For Hours After Passing Stools. The Chronic Fissure Pain Is Due To Spasm Of The Internal Sphincter Muscle And Can Be Quite Debilitating.
- Severe Spasm Of The Anal Sphincter.
- Blood Streaks On Stool : The Bleeding Associated With A Fissure In Ano Is Bright Red And Associated With Some Pain Or Tenderness In The Anus. It Usually Occurs As Streaks On The Outside Of The Stool, Or Spots Noted On Toilet Tissue.
- Discharge, Swelling And Pruritus Ani (Anal Itching) Occur Especially With Chronic Fissures.
- Anorectal Fissures Or Anal Fissures May Present As ACUTE FISSURE Of Recent Origin (Less Than 6 Weeks Of Duration). At This Stage Fissures Are Superficial. Some Of Them May Deepen To Reach Underlying Layers And Present As Chronic Fissure Of A Long Duration (More Than 6 Weeks Of Duration) Or Recurring Fissures.
Diagnosis Of Anorectal Fissure
Clinical examination of the patient is required to diagnose this condition; no complicated procedures are required. With careful evaluation of the symptoms and a close look at the anus, a diagnosis of fissure can be confirmed.
- A Tightly Closed Puckered Anus Is Seen Which Is The Diagnostic Point Of This Condition.
- A Split Or Cut In The Posterior Midline Of Anal Mucosa.
- Lateral Fissures.
- Acute Fissures Are Superficial With Sharply Demarcated Edges.
- Chronic Fissures Are Usually Deeper And May Have Secondary Features, Including Hardening Of The Edge Of The Fissure, A Sentinnel Pile Which Looks Like A Small Skin Tag And Hypertrophied Anal Papillae And So On.
Home Remedies For Anal Fissure
- Several Times A Day, Sit In A Warm Sitz Bath For 20 Minutes. This Relaxes The Anal Sphincter, Reducing Spasms And Their Associated Pain.
- Prevention Of Anorectal Fissure Involves Avoiding Constipation And Diarrhea Through Diet And Exercise.