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Anal Fissure - Symptom, Treatment And Causes

Anal fissure occurs because of a tear or cut in the anus, that extends up into the anal canal. Anal fissures are a common condition that happens with many people across the globe and are responsible for 6-15 patient percent visits to a colorectal surgeon.

Anal fissure can happen to anyone. Both men and women, young and old are affected with this malady. Fissure in the anal tract causes severe pain during defecation and bowel movement. In fact fissure in the anus, is the most common cause of rectal bleeding during childhood and infancy. Anal fissures typically happens in the specialized tissue that lines the anal canal and anus, known as anoderm. Unlike skin, anoderm do not have sweat glands, hairs or sebaceous glands. But it has a plethora of sensory nerves that can even sense light touch and pain. This abundance of nerves in the anoderm tissue is what makes anal fissures so painful. This most sensitive anoderm moves up for the entire length of the anal canal till it ends and meets the demarcating line where the rectum starts, which is known as the dentate line.

Anal fissures are caused owing to trauma in the anal canal or in the anus. The most common cause for this trauma is bowel movement. So anal fissures can always be caused by repeated episodes or diarrhea or hard stool (constipation). Many a time insertion of an enema tip, rectal thermometer, ultrasound probe (for examination of the prostate), and endoscope can result in enough trauma for development of an anal fissure. During childbirths, trauma in the perineum tissue, can also cause a tear that can extend into the anoderm. The most common location where this disease is diagnosed is the part of the anus, which is closest to the spine.

Other causes for development of this malady are infectious diseases are viral infections like herpes, gonorrhea, syphilis, chancroid, chlamydia, tuberculosis and HIV. Also patients who suffer from Crohn’s disease, 4% of such patients develop anal fissures as the primary manifestation of their disease. Anal fissures are diagnosed by physical examination of the patients. In case rectal bleeding is present sigmoidoscopy and colonoscopy are done at times to confirm the diagnosis. Even in the case of acute fissures, non-operative therapies proves successful in majority of the patients. Initial treatment of this painful colorectal disease involves prescribing stool softening medications, followed by increase in liquid intake and sitz bath.

Sitz bath increases the flow of blood to the anus, which relaxes the rectal spasm and cleans the anus without irritating the anoderm, if done particularly after passing of the stool.

Treatable by medical professional Require medical diagnosis Lab test required Short-term: resolves within days to weeks Non communicable
Blood in stool Constipation Itchiness around the anus

Popular Health Tips

Piles, Fistula & Fissure- Healing by Ayurveda!

Dr. Ashutosh Srivastava 85% (49 ratings)
Ayurveda, Lucknow
Piles, Fistula & Fissure- Healing by Ayurveda!
Piles, fistula and fissures are the most common problems affecting the rectum and the anus. Both the rectum as well as the anus has a very rich vascular supply. There could be swelling of these blood vessels or tearing which can lead to the above conditions. Read on to know additional details about each of these conditions. Piles: In simple words, swollen blood vessels of the anal region are called piles. It can be internal or external, depending on how far it is from the anal canal. If it is located farther inside the anal canal, it is called internal piles. Causes: Chronic constipation, where the person has to strain to pass stools Smoking and genetics can also lead to piles. Symptoms: Starts off as painless bleeding, which happens in drops after bowel movement; the swelling happens much later. They can continue to grow and develop blood clots. Treatment: In the early stages, once identified, simple topical medications for symptom relief are sufficient. Diet should be rich in fiber, with fruits and vegetables Increased water consumption Surgery if the disease has reached the stage of blood clots Prevention is advised if there is a family history by consuming a fiber-rich diet and maintaining hydration Fistula: When an infected anal gland bursts into the anal canal, it constantly discharges pus into the anal canal and becomes a fistula. Hygienic toilet habits can help in preventing fistulas. Symptoms: A constant wet feeling in the anal area, due to pus discharge. This would be intermittent, and there would be periods with no discharge. There could be a foul smell due to pus discharge. Diagnosis and Treatment: Identifying the exact location is important as surgery may be required. An ultrasound scan or an MRI is usually done. Newer techniques like Video Assisted Anal Fistula Treatment (VAAFT) are used. This locates the piles accurately and uses electric current to seal it with staples and surgical glue. Conventional surgery is also used for economic or accessibility reasons. Fissures: These cracks anywhere in the length of the anal canal are extremely common. Symptoms Very painful and the person may not want to go to the toilet Rarely bleeding is also seen, maybe in very small amounts Treatment: Over 90% of the fissures do not require surgery Switching to a high-fiber diet and improving hydration will help in managing these symptoms. Topical relief can be provided by medications. When they are recurrent, a procedure known as lateral sphincterotomy is done. This is an outpatient procedure and provides immediate relief. Though one condition can lead to another, in most people, there is a strong genetic component, and working towards prevention is highly recommended.
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Anal Fistula Can Now Be Completely Cured Without Surgery!

Dr. S K Singh 89% (55 ratings)
M.S. (Ayurveda), Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Delhi
Anal Fistula Can Now Be Completely Cured Without Surgery!
Anal fistula, a challenge for modern surgery, but can be cured with grade ksharsutra in Ayurveda (Indian system of medicine). Anal fistula is a disease for which different methods of treatment have been advocated time to time, even today when we are talking about robotic surgery, this disease has no satisfactory method of treatment in modern surgery. The latest method of video assisted anal fistula treatment (VAAFT) is not satisfactory due to high incidences of recurrence after the surgery. But at Sushruta Anorectal Institute New Delhi; with the help of Graded KsharsutraTM all these patients of complex Anal fistula are being successfully treated. In Ayurveda about 2000 yrs ago Acharya Sushruta has indicated ksharsutra treatment to treat fistula-in-ano. Late professor P J Deshpandey at the faculty of Ayurveda Institute of Medical Sciences B H U; had done extensive research in this field and established a treatment module to cure this disease. In 1990 Indian council of medical research has clinically evaluated this Ayurvedic treatment module at four premiere institutes in our country including AIIMS Delhi & PGI Chandigarh. Subsequently, it was concluded by I.C.M.R. that in the patients of fistula in ano, ksharsutra treatment is more effective& convenient as compared to modern surgery. Ksharsutra is a thread coated with certain Ayurvedic medicines known for their antiseptic, debridement & healing properties. After u v sterilization this medicated thread (ksharsutra) is used under complete aseptic precautions in the patients. The patient is routinely investigated with special reference to any other associated disorder like hypertension, diabetes mellitus, tuberculosis etc. The next step lies in the proper identification& evaluation of the fistulous tract. It is mandatory to define the fistula tract wrt its depth, direction & branching pattern. This may be achieved by careful probing under expert hands using malleable probes& if required help may be taken from other investigations like x-ray fistulogram or MRI fistulogram. Once the tract has been clearly defined the Ksharsutra is placed in it with the help of certain instruments, under local anesthesia. This entire procedure is usually completed in ten to fifteen mins. As there is no cutting of tissues hence no bleeding, no pain & patients can go home after half an hr rest in the daycare room. The medicine-coated on the thread is gradually released in the tract. The cumulative effect of the coated drugs exerts a powerful debridement effect on the fistula tract & induces healing by the fresh & healthy granulation tissues. Thus Ksharsutra is the mechanism of drug delivery precisely at the tissues involved. Every seventh or tenth day the old sutra is replaced with a new Ksharsutra till there is a final cut through. It has been observed that the tract heals @ 0.5-1 cm per week. The post-operative complications like recurrence of the disease, fecal incontinence, bleeding is not seen with Ksharsutra treatment. Further, this therapy is performed as an OPD procedure. No general anesthesia & no hospitalization is required. Patient maintains his normal routine activities as usual during the treatment period. At Sushruta Anorectal Institute; Rohini - New Delhi, we have been working on this disease including piles fissures & pilonidal sinus for the last 30 yrs. Here we have developed the concept of Graded KsharsutraTM which has given us a more effective & convenient way to treat anal fistula. At Sushruta Anorectai Institute we have treated on record thousands of patients of anal fistula from different states including overseas patients. We have records to prove that the patients of high anal complex fistula, those have been operated two or three times but failed to heal were successfully treated at this institute.
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Anal Fissure

Dr. Ashok Gupta 88% (5452 ratings)
MS - General Surgery, MBBS
General Surgeon, Delhi
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Hi, I am Dr Ashok Gupta, practising since last 37 years as a general surgeon, Laparoscopic surgeon and Gastroenderoscopist. Today we are going to discuss the most common problem that is Anal Fissure. Anal Fissure is such a problem which is very prevalant in our community, may be the raeson of the pattern of the diet, constipation, inactivity, Obesity Diabetes and other inactive way of diet. Anal fissure is the breech in the skin which are there from the anal walls to the rectum in lower part. This is about 2-3 cm in size and this anoderm is more sensitive and lacking in sweat glands and hairs. Once the hard motion is being passed or the person is constipated, there occurs a breech in the skin which leads to severe pain while passing the stool sometime otherwise also. This linear breech is not going to heal by any chance, it mostly requires medical interference. Medical treatments are responsive at times but once it get failed, then surgery is only the answer. The surgery is very simple in this case. We just relax the sphincter because sphincter always give the spasm to the fissure which is not allowing it to heal and it always gives the problem in later times. The surgery being done under general anaesthesia and spinal anaesthesia, just to relax the sphincter. After the cure is there, so it is not going to create problems. But the complicated anal fissure has to be dealt with the "fissure act me" in which the fissure is being removed. If you have nay query or if you want to contaact me, you can come to my clinic Tirupati Medical Centre in Malviya Nagar. Also, you can contact me through Lybrate.
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Anorectal Diseases - Piles, Fissure, Fistula Signs You Are Suffering From It!

N.D.D.Y, Bachelor of Ayurveda, Medicine and Surgery (BAMS), specialist in ayurvedic ksharsutra therapy
Ayurveda, Delhi
Anorectal Diseases - Piles, Fissure, Fistula Signs You Are Suffering From It!
The last part of the digestive system including the rectum and the anus is a highly vascular area. It receives a rich blood supply, and there could be swelling or tearing of these blood vessels resulting in anorectal conditions, piles, fistula, or fissures. Seeing blood in the toilet bowl can be an alarming thing. Read on to know how these occur and how to manage them effectively. Piles: The swollen blood vessels in the anal region are referred to as piles. These can be internal or external, based on the distance from the anal canal. The ones which are farther inside the anal canal are called internal piles. Why they occur: Genetic Smoking Chronic constipation Symptoms: At the outset, piles present as painless bleeding with stools. This can be painless, and if left untreated, they can continue to grow and develop swelling and clotting. Treatment: This would be two pronged with medicines to treat and food habits to prevent further growth of piles For pain relief, topical medicines can be used Dietary habits should be modified to include fiber-rich diet, with loads of fruits, whole grains, and vegetables Processed and refined foods should be avoided Hydration is very important in treatment and prevention Fistula: An infected anal gland bursts into the anal canal, discharging pus constantly into the anal canal and becoming a fistula. This is mainly caused by unhygienic toilet habits and healthy toilet habits can prevent fistulas. Symptoms: There is a constant discharge of pus, giving a constant wet feeling. It could also be intermittent, with completely dry spells in between There may or may not be pain, but when there is pus discharge, there could be a foul smell Prevention is very easy and should be followed. Healthy toilet habits can help avoid fistula formation Diagnosis and Treatment: Prevention is the key in anal fistula In severe cases, since this is internal, surgical correction may be required Fissures: Cracks in any point along the length of the anal canal are called fissues and are very common. These are very painful and the person may dread going to the toilet. Symptoms Fissures are very painful, and a person with fissures usually refuses or avoids going to the toilet In severe cases, there could be bleeding too, though in small quantities Treatment: It is often self-limiting Lifestyle changes like switching to a fibrous diet and adequate hydration Topical ointments for pain relief Ayurvedic Treatment for Anorectal Diseases: Ayurvedic Treatment: According to ayurveda, a disease occurs due to an impairment of the body energies. Ayurveda believes that the imparement of digestive system with the predominance of apana vata is the cause for fissures, and if bleeding occurs, it is due to Ranjaka Pitta. Ayurvedic Treatment for Anal Fissure improves digestion and metabolism. The treatment modalities includes Kshara Karma, panchakarma, external therapies, internal medications, Activities, Advice of food and life style changes. Infrared Coagulation(IRC): IRC has been used for many years to treat internal hemorrhoids. It is less painful than surgery and can be preformed in the physician s office. IRC involves the application of infrared light to the base of the hemorrhoid, which clots the hemorrhoid. Although you will occasionally feel the warmth, there generally is minimal pain or discomfort.You may return to your normal lifestyle immediately after treatment.Usually 3 to 5 treatments are required at 2 to 3 week intervals to obtain the desired result. KSHARA SUTRA THERAPY (MEDICATED CAUSTIC THREAD): Kshara Sutra therapy is a minimal invasive Ayurvedic Parasurgical procedure and time-tested Ayurvedic technique in the management of Anorectal disorders. It is a safe, sure and cost effective method of treatment for fistula-in-ano, haemorrhoids and other sinus diseases.

Causes, Symptoms and Treatment for Anal Fissures

Dr. Vijay Rai 86% (18 ratings)
Gastroenterologist, Kolkata
Causes, Symptoms and Treatment for Anal Fissures
Anal fissures are the small tears formed in the anal lining. They are also known as anal ulcers. An anal fissure causes a lot of pain and bleeding during your bowel movements. Usually a fissure heals automatically in a few days time. It can be treated with simple home remedies as well. Causes: You can suffer from an anal fissure if you pass hard and large stools. Also strained childbirth or suffering from violent spells of diarrhea might get you an anal fissure. Chronic constipation may also be cause of a fissure. Other rare causes may be anal cancer, HIV, tuberculosis or herpes. Individuals of all age groups can suffer from anal fissures. It is not a very serious problem and heals on its own in a few weeks. Although it can heal itself, there are certain treatments which can help relieve the pain you get from an anal fissure. Symptoms: An anal fissure has quite a lot of symptoms for you to understand what you are suffering from: There will be a very visible tear around the anal region. You will be able to spot the tear on the skin very easily. A small lump of skin may form next to the tear. When you will be undergoing your bowel movements, you will feel a very sharp pain in the anal region. You will find spots of blood on the stool passed. You will also feel a burning or an itching sensation in the anal region. Treatment: Although most fissures do not require treatment, there are a few remedies that will help cure them faster: Stool softeners: You get certain medicines at the chemist, which are known for their stool softening functions. These stool softeners help to soften the hard stools and initiates smooth bowel movements. Eat fibrous foods: Eat foods rich in fiber like fruits, whole grain cereals, raw vegetables, etc. Take warm baths: Take a bath in warm water as it relaxes your anal muscles, helps to relieve irritation in the region, and increases blood flow in the anorectal region. Use ointment: Apply nitroglycerin ointments and topical pain relievers to promote blood flow to the anal region and to relieve discomfort from the region respectively.
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Popular Questions & Answers

I have hemorrides problem and I felt very difficulties in passing stool and not pass stool and found small anal fissure, mild proctitis, grade 1 internal and external mass+ hemmorides please suggest me something.

Dr. Bhagyesh Patel 93% (2479 ratings)
General Surgeon, Gandhinagar
Respected lybrate-user, hi Warm welcome to I have evaluated your query thoroughly.* This needs multi modality management as - Drink plenty of liquids.- Soft, light diet.- Avoid oily, spicy,non veg, hot beverages.- High fiber diet to get soft stools.- Tab. Ibuprofen as pain killer.- Ispaghula husk for getting soft stools.- Xylocaine (5 %) jelly application over the local area.- Sitz bath (sitting in tub filled with lukewarm water 5 minutes each 3 times a day, additionally after passing stools)- Avoid smoking, alcohol if doing.- Avoid stress, anxiety Hope this will help you for sure. Welcome for any further assistance. Thanks dear regards take care.

Why fissures in ano or anal ulcers is best known to recur again and again? Even why after surgery still it is coming?

Dr. Aastha Midha Likhyani 88% (684 ratings)
MBBS, M S General Surgery ,
General Surgeon, Chandigarh
Hi fissure in Ano require very good diet intake. If you take lots of fluids and green leafy vegetables, and boiled vegetables. You will be much better. Avoid constipation and sit in warm water three times a day. Do it for fifteen days and contact me again after fifteen days.

Blood is coming out through anus when I'm going for lavatory. There is no pain. What is the simple solution for anal fissure.

Dr. Rahul Saboo 91% (15 ratings)
MS- General Surgery
General Surgeon, Nagpur
You are suffering from hemorrhoids. Thats the most common cause for bleeding while passing stools. However you need to see a doctor for the same to confirm it's nothing else. Hemorrhoids do not pain, anal fissure is associated with pain.
1 person found this helpful

How much time anal fissure takes to get cured if treatment is going on without surgery through ointments?

Dr. Suvendu Maji 92% (372 ratings)
MBBS, MS - General Surgery
General Surgeon, Kolkata
Small minor ansl fissure are often responsive to ointments if yu apply them regularly and afopt life style changes. It shoud take 4 weeks only.

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