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Overview

Anal Fissure - Symptom, Treatment And Causes

What is Anal Fissure?

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.

Causes :

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
Symptoms
Blood in stool Constipation Itchiness around the anus

Popular Health Tips

How Fistula-in-Ano Can Be Treated With Surgery?

MBBS, MS - General Surgery, MCh - Cardio Thoracic Surgery
General Surgeon, Lucknow
How Fistula-in-Ano Can Be Treated With Surgery?

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

  1. Pain- Constant pain which gets worse when sitting down
  2. Irritation around the anus, like swelling, redness and tenderness
  3. Discharge of blood or pus
  4. Constipation or pain while evacuation
  5. 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.

  1. 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.
  2. 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.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2802 people found this helpful

Fistula In Ano - Success Rate In Ayurveda

B.A.M.S
Ayurveda, Gorakhpur
Fistula In Ano - Success Rate In Ayurveda

Fistula in ano or bhagandar is very much recurrent disease means, d first thing is when a person have anal fistula then it itself some times look like it is completely gone by time, but suddenly after few days, weeks, months or years it appears with all it's features. And a person with few medications like antibiotics or homoeopathic medications, if case is not taken properly, it again behaves the same. It's very recurrent even after surgeries. Now what I have learned in my practice and in my institutions, the kshar sutra method of ligation of fistula, completely cures the fistula in ano. And also it doesn't harm the rings of anus, so that it doesn't cause any incontinence.

3 people found this helpful

Piles, Fistula and Fissures - Know How Ayurveda Is Effective in Treating Them!

B.U.M.S
Ayurveda, Etawah
Piles, Fistula and Fissures - Know How Ayurveda Is Effective in Treating Them!

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.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2997 people found this helpful

Medication In Fistula In Ano

B.A.M.S
Ayurveda, Gorakhpur
Medication In Fistula In Ano

I want to discuss on anal fistula medication. If there is a patient of fistula asks you to recommend some medication please tell him clearly that there is no any medication needed other than Kshar Sutra ligation in fistulous tract. No need of any medicine after ligation before or after because if you give any medicine like antibiotics or even homoeopathic medicine if not consulted properly it will bock the track of fistula and it will cause worsening of fistula because it will make more tracs in fistula.

2 people found this helpful

How Ayurveda Can Help Manage Piles & Fissures?

BAMS, MD - Alternate Medicine
Ayurveda, Vadodara
How Ayurveda Can Help Manage Piles & Fissures?

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:

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. In case you have a concern or query you can always consult an expert & get answers to your questions!

4651 people found this helpful

Popular Questions & Answers

Air I have anal fissures from last two months and tried ayurvedic medicines and some laxatives .my pain has decreased very much only slight discomfort during defecation but I have a skin tag outside my anus and its pink in color and bleeds sometimes I don't understand what it is currently I am using dilt ointment as suggested by surgeon plss help.

MS - General Surgery, FMAS.Laparoscopy
General Surgeon, Gandhinagar
Hello dear Lybrate user, Warm welcome to Lybrate.com I have evaluated your query thoroughly. This is sentinel tag does not go away by medicines or ointment best help with sitz bath and laxatives which will keep stool soft. If more problematic can get surgery for life time cure, but when not much discomfort, surgery is not advisable Hope this clears your query. Wishing you fine recovery. Welcome for any further assistance at my private URL https://www.Lybrate.com/gandhinagar/doctor/dr-bhagyesh-patel-general-surgeon Regards take care.
1 person found this helpful

Sir, I have an anal fissures from last two months .in starting it was painful but now it doesn't cause pain but slight discomfort. I have taken an ayurvedic treatment and laxatives .now my surgeon has recommended a diet ointment .my only concern is I have a skin tag outside the anus which is pink in color and bleeds sometimes I don't understand what it is a sentinel pile or papilla?

DNB(Gastroenterology), Gujarat University
Gastroenterologist, Ahmedabad
If you have constipation than take 1) Liquid cremaffin 3tsf at bed time 2) Take hot sitz bath (put warm water in a tub and sit in the water for 10-15 minutes) If you are still not Ok than consult surgeon.

I am 24 four year old male and I have facing problem with anal fistula disease. What is the treatment of anal fistula beside operation because I was operate it 2 years back but it again happen and not fully developed till now.

MCh(Minimally Invasive & Robotic Surgery), MS - Surgical, MBBS
General Surgeon, Barpeta
Try to avoid conatipation by increasing water and vegies intake daily. Hot sitz bath with betadine solution is very helpful. Oint ESCOT twice daily, digitally .sply before going to the toilet. Or Lateral Sphinterotomy.
1 person found this helpful

Hi everyone, After my Anal fistula surgery my wound is healing. I feel little pain while it's healing. It's almost 2 weeks it my wound is covering up with skin but with little pain. My doctor says it is normal process until the heal is completely heal and cover by skin it will have little pain. Kindly assist does it is normal process. Thanks .

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda,
It totally depends upon fistula type, and procedure type. If wound is clean, then there shouldn't be any pain. If it is under cleaning phase then paon os acceptable. But if at time of your wound closure/ complete healing pain occurs, it isn't acceptable.

Please suggest. Is anal fissure is related to piles? Does its only solution is surgery?

MS-General Surgery, MBBS
General Surgeon, Hyderabad
Anal fissure and piles are 2 different diseases. They are not related to each other. Surgery is not the only treatment it can be cured by medicines, injection of botox, laser or surgery.
1 person found this helpful