Fissure in Ano, also known as Anal Fissure, is basically a small longitudinal cut in skin that lines the opening of the anus. Fissures cause bleeding and severe pain in the bowel movements. These are very common in the general public, but often confused with other pain. A fissure can happen at any point in your lifetime and can have equal general distribution.

Types of Fissure in Ano:

  Acute Fissure: Fissure in Ano less than 6 weeks of duration is known as Acute Fissure.

  Chronic Fissure: Anal Fissure with more than 6 weeks of duration is known as Chronic Fissure. 

Causes of Fissures in Ano:

  Anal fissures are basically caused by stretching of the anal muscles beyond its capability.

  In adults, it is caused by the passing of large stools, constipation or by prolonged diarrhea.   In older adults it is caused by the less flow of blood to that area.

  It is also caused by sexually transmitted infections (syphilis, chlamydia, herpes) and it results in fissures.

  Anal sex can also be the cause of fissures.

Symptoms of Fissures in Ano:

  Tear in the skin around the anus

  Small lump of skin, or skin tag next to the tear

  Pain during bowel movement

  Stools with blood or pus

  Itching and burning in the anal area 

Preventions During Fissures in Ano:

  One should drink enough water.

  One should have high fibre diet so that one does not suffer from constipation.

  Be careful and hygienic after anal defecation.

  In case of suspected fissure or any kind of pain, use a lubricating ointment.

  Sit in lukewarm water

Treatment for Fissures in Ano

Surgical treatments are not recommended, but there are some other measures that can be taken and are listed as follows:

  Some prescribed medication to lower the severity of pain.

  Nitroglycerin ointment may help heal the fissure.

  Having a rich fiber diet as a lifestyle change.

  Drink enough water as that helps in softening the stool.

  Sometimes Stool softeners may be required to soften the bowel movement.

When Anal Fissure does not heal with all of the above listed things, then a surgery may be required:

  Lower most part of the internal anal sphincter is divided laterally. With this acute fissure heals of its own. In chronic cases one may require to undergo fissurectomy.

  The surgery decreases the anal pain and spasm, allowing the fissure to heal.

  If a sentinel pile is present, it is removed to heal the fissure. 

It is important to note that any kind of treatment requires 6-10 weeks to recover. However, the pain may disappear just after 2-4 days after the surgery. One must consult a doctor before going for any treatment. This surgery can also be performed with LASER,where there is less trauma and early recovery is posssible.

Fissure In Ano

Anal Fissure is a small tear in the anal area. This can happen due to injury while passing hard formed stool or even by repeated bowel motion. It may be very painful especially at the time of passing hard stool. 

Symptoms

Most commonly sought symptoms in Anal Fissure are as given below: 

  A noticeable tear in the skin close to the anus. 

  Cutting or burning pain in anal passage while passing stool which may persist for a considerable time

  Sometimes pain is so severe that patient stops eating in an attempt to avoid defecation to avoid pain

  Blood stains on stools may also be there

  If not treated in time; skin starts growing from the lower end of fissure to form a tag known as sentinel tag/sentinel piles.

  At times; sentinel tag may get inflamed.

Causes

  Passage of hard stool through anus. 

  Chronic Diarrhoea

  Trauma to the anus and anal canal like during childbirth

  Inflammation in anus because of crohn's disease or some other inflammatory disease 

Anal Fissure treatment: Diet: High fiber diet like green leafy vegetables, salads, fruits like papaya, chikku are advised. Resins with milk can also be taken in night. Adequate quantity of liquids especially butter milk is advised. Banana, apple etc. should be avoided. 

Graded Kshar Karma & Ksharsutra: Anal Fissure can be completely treated by Graded Kshar Karma and Ksharsutra treatment. In acute anal fissure; stool softener along with Graded Kshar Karma is advised. In this treatment; Graded Kshar - a specialized Ayurvedic medicine is applied in fissure region. This medicine debrides the fissure and induces healing. Usually pain subsides in a week or 10 days time period when fissure is still in healing phase.

Considering pain has subsided; some patients discontinue the treatment to further aggravate and complicate the problem. For complete healing of anal fissure usually 3-5 Graded Kshar Karma sittings are required at a weekly interval. In between these weekly sittings patients are advised to apply certain medicines in anal passage by themselves. If anal fissure has progressed to development of sentinel tag then Graded Ksharsutra TM treatment is the treatment of choice. 

In this treatment Graded Ksharsutra TM is ligated at the root of sentinel tag. Medicine released from Ksharsutra blocks the blood supply of sentinel tag and it sheds off in a week or 10 days time period. No hospitalization or bed rest is required in this treatment. Patient can continue his normal routine activities as usual during his treatment. So, you can say no to surgery in Anal fissure.

Anal Fissure - Say No To Surgery!

There are glands inside the anus that secrete fluids. Sometimes these glands can get clogged. Pus builds up in the blocked clogs, which get infected. This is called an abscess. Unless the abscess is treated right away, it will keep growing. It eventually punches a hole through the skin near your anus to drain the infected tissues and pus. This tunnel that leads from the gland to the hole is called a fistula.

Usually, it is an abscess that causes a fistula. But sometimes a fistula can be caused by tuberculosis, a bowel illness or sexually transmitted diseases.

What are the symptoms of anal fistula?

The symptoms of anal fistula are-

  Pain while sitting down
  Soreness around the anus
  Swelling and redness
  Bleeding
  Painful defecation
  Fever
  Foul secretion from a hole near your anus

How is fistula diagnosed?

If you complain of any of the above symptoms, a doctor will perform a physical examination on you.

Sometimes a physical examination does not reveal a fistula because the fistula can close for a while and then open up again. So then your doctor might ask you to get the following tests done-

  A blue dye test
  Computerized tomography (CT Scan)
  Anorectal ultrasound
  Colonoscopy.

Treatment for anal fistula

Unfortunately, there are no medicines that can treat fistula. If you are diagnosed with fistula, you will require surgery. However, it is a minimally invasive surgery with no risks involved.

The surgery is performed under general anaesthesia. A fistula surgery can be done in the following ways-

  If the fistula is located beneath the sphincter muscles, the surgeon cuts the fistula open so that it can heal and new healthy tissues can develop there.
  If the fistula passes through the upper part of the sphincter muscles, then the surgeon runs a special stitch through the fistula (seton stitch) so that the fistula can drain properly and heal. It takes 6 weeks for the pus to drain and the wound to heal
  Sometimes, a doctor will simply plug the fistula so it does not seep pus.

General and specific complications of a fistula surgery

Though it is a safe surgery, some complications may arise, but rarely. These may be general or specific.

General complications-

  Bleeding and pain
  Scarring around the region of the surgery

Specific complications-

  Pain while urinating
  The involuntary passing of wind or lose faeces

An anal fistula is a painful condition that refuses to go away and the only way to cure it is surgery.

Can Medication Treat Anal Fistula? Find Out!

An anal fistula, is also called as fistula- in -ano, it is a small channel that develops between the end of the large intestine called the anal canal and the skin near the anus. This is a painful condition, especially when the patient is passing stools. It can also cause bleeding and discharge during defecation.

Genesis of fistula-in-ano
Almost all anal fistulae occur due to an anorectal abscess that begins as an infection in one of the anal glands. This infection spreads down to the skin around the anus causing fistula-in -ano. The anorectal abscess usually leads to pain and swelling around the anus, along with fever. Treatment for anorectal abscess involves incising the skin over the abscess to drain the pus. This is done usually under local anesthesia. A fistula-in-ano happens when there is failure of the anorectal abscess wound to heal completely. Almost 50% of patients with an abscess go on to develop a chronic fistula-in-ano.

Symptoms

Pain- Constant pain which gets worse when sitting down
Irritation around the anus, like swelling, redness and tenderness
Discharge of blood or pus
Constipation or pain while evacuation
Fever
Diagnosis
A clinical evaluation, including a digital rectal examination under anesthesia, is carried out to diagnose anal fistula. However, few patients may be advised screening for rectal cancer, sexually transmitted diseases and diverticular disease.

Treatment
The only cure for an anal fistula is surgery. The type of surgery will depend on the position of the anal fistula. Most patients are treated by simply laying open the fistula tract to flush out pus, called Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months.

Seton techniques: A seton is a piece of thread (silk, plastic) which is left in the fistula tract to treat anal fissures. This is used if a patient is at high risk of developing incontinence after fistulotomy.
Advancement flap procedures: When the fistula is considered complex, carrying a high risk of incontinence, then this advanced technique is used.
Other techniques like Fibrin glue and Bioprosthetic plug are also used to surgically treat anal fistulas. In the Fibrin glue technique, glue is injected into the fistula to seal the tract, after which the opening is stitch closed. Bioprosthetic plug is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. After this stitches are used to keep the plug in place. 

Whatever the surgical technique, one can experience minor changes in continence. Patients usually don t require antibiotics after surgery but have to take pain medication. They may also have to use gauze to soak up drainage from anus. After surgery, patients should seek help if they have increased pain or swelling, heavy bleeding, difficulty in urination, high temperature, nausea or constipation.

Fistula-in-Ano or Anal Fistula - How It Can Be Treated?

An Anal fistula (also known as fistula-in-ano) is a small tunnel that can develop between anal canal and the skin near the anus often resulting from an untreated or inadequately treated perianal abscess. No medicinal treatment shows complete cure of anal fistula except few conditions like tubercular fistula. Early surgery, short & straight fistula tract and anal fistula treatment with ksharasutra give promising results with high rate of success.

Fast facts on Anal fistula:

Essentially surgical intervention required.
Recurrence is common.
Should be planned for surgery as early as possible, late cases are mostly complicated.
Anal fistula treatment with ksharasutra shows high rate of success.
What Causes Anal fistula?

Abscess in buttock and/or around the anus.
Long standing anal fissure.
Traumatic injury to the perianal region.
Tuberculosis.
Crohn s disease.
AIDS.
Not maintaining local hygiene.
What are the symptoms of Anal fistula?

Discharging wound at perianal region or buttock which is repeatedly swelling, discharging some amount of pus and/or blood and resolving. The swelling is often associated with pain and fever.
There may be single or multiple wounds.
Passing of flatus through the tunnel like wound.
Anal fistula is notoriously famous for its recurrence even after repeated surgery. An anal sphincter sparing or minimal invasive surgery should always be the choice of patient as well as surgeon. Two stage seton fistulotomy and multistage anal fistula treatment with ksharasutra have shown promising result with lowest rate of reported recurrence and complications like incontinence of stool.

Benefits of treatment with ksharasutra:

Very less incidence of recurrence.
Least chance of post operative stool incontinence.
Minimal invasive procedure.
Minimal blood lost.
Cutting of tract and its healing goes on simultaneously.
Can be performed in elderly patients.
Can be performed in diabetic patients.
Less hospital stay
Patient can continue normal life after a sitting of ksharasutra replacement.

Anal Fistula - Know The Symptoms & Ayurvedic Treatments For It!

The area in and around anal region is some time affected with pain swelling and pus or watery discharges. This abnormal presentation may be due to anal fistula. It is characterized by a nodular swelling in or around anal region with occasional pain and watery or blood mixed pus discharge. The symptoms might be mild but as the time passes the fistulous tract may become deep and develop multiple branches with multiple openings. This makes the treatment more difficult. Therefore it is always advisable as soon as this condition is diagnosed it should be treated promptly to avoid further complications. 

Causes: The causes of anal fistula are many. The major reason is the formation of pus. Incompletely cured abscess, microbial infection, ulcers, inflammation of anus and the region around it, and complications that arise out of a surgery can cause the anal fistula. The individuals suffering with diabetes, ulcerative colitis, malignancies and also individuals undergoing chemo or radiotherapy or having some other immune compromised conditions are prone to develop anal fistula. 

Treatment: Practically it has been noticed that any amount of oral medications either from allopathy/ homeopathy or Ayurveda is not of much help. In allopathy the surgeons usually advice Fistulectomy i.e. complete excision of fistulous tract or VAAFT   Video Assisted Anal Fistula Treatment. However in both these case a fairly high incidence of recurrence has been noticed. In Ayurvedic surgery; Fistula has been categorized among eight diseases which are difficult to cure. A highly specific Ksharsutra procedure has been advised in Ayurvedic surgery to treat this problem. Subsequently, efficacy of this Ksharsutra therapy was compared with surgery in 1991. This clinical trial was conducted by Indian Council of Medical research at AIIMS New Delhi and PGI Chandigarh. They have clearly reported that Ksharsutra treatment is more convenient and more effective as compared to surgery in the patients of Anal fistula. The recent concept of Graded Ksharsutra has further improved the efficacy of this therapy. Facility of Graded KsharsutraTM is available only at Sushruta Ano rectal Institute Rohini; New Delhi. 

Ksharsutra Therapy: It is a highly specific and most effective amongst all available treatments for the patients of Anal Fistula. In this treatment; the first step consists of proper identification of fistulous tract with respect to depth, direction and branching pattern. This is usually achieved by careful probing or taking the help of MRI Fistulogram, Ultrasound etc. One the tract has been defined Ksharsutra is placed in the tract with the help of malleable probes under local anesthesia. Since there is no injury to the soft tissue hence no pain or bleeding is expected after this treatment. Patient can continue his routine activities as usual from the very first day. The Ksharsutra   medicated thread is changed at weekly interval. Usually the Fistula heals @ 0.5 to 1 cm per sitting. Therefore the anal fistula which is 4-6 cm long they usually heal in 8-10 sittings. After Ksharsutra Treatment the sphincter control remains normal and the fistula heals completely.

Anal Fistula - How Can It Be Treated Using Ayurveda? 

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