Anal Fissure Tips

Anal fissure, better known as fissures refer to tear or cracks in the lining of the anal canal. This results in extreme pain during and after bowel movements. At times, people might find blood in their stool due to this particular problem. As already mentioned the most common symptoms are pain, stool with blood in them, itchiness in the anal area and an uncomfortable situation while urinating, known as Dysuria.

The ayurvedic treatment through Panchakarma, especially Basti, which is a part of Panchakarma therapy involving elimination of toxins present in the lower colon through the usage of an Ayurvedic enema like milk, ghee.
Before going into the details about the part of Panchakarma treatment, Basti, let’s discuss about Panchakarma ayurvedic therapy.

Panchakarma
Panchakarma is a process used to clean up body’s toxic materials, left behind by disease and poor nutrition. Generally our bodies have innate abilities to efficiently process and remove waste materials but with repetitive dietary indiscretions, almost no or poor exercise patterns, lifestyle, the digestive enzymes, hormones and agnis which regulate the body’s internal homeostasis become disorganized. This leads to the accumulation and spreading of toxins throughout the body, resulting in diseases. Digestive problem and constipation due to lack of food intake, containing fibres, while continuous consumption of high protein items invite the problem of constipation, thereby giving rise to fissures.

Panchamarma is a Sanskrit term that means “five actions” or “five treatments”. Through these five types of treatments, according to the needs and requirements of individuals, it removes the excess doshas and help rectify the imbalances in them and also eliminate harmful substances out of the body through it’s different organs like colon, sweat glands, lungs, bladder, urinary tract, stomach, intestines etc.

Remedies in Panchakarma for Fissures
Ayurvedic remedies are all very efficient and help in avoiding the need for surgery treatment in many of sufferers of Anal Fissure. These natural remedies can cure lot of ano-rectal issues and ensure normal bowel movements up to 90%.

• These remedies are particular useful for those who are not willing for go for surgeries or other medical treatments.
• The five treatments of Panchakarma are Vamana, Virechana, Basti, Nasya and Rakta Mokshana. Out of these methods, implementing the method of Basti helps in providing relief from the painful problem of Fissures.
• Ayurvedic Basti involves the introduction of herbal substances like oil and decoction in a liquid form, into the rectum. Through the use of this therapy, the herbal substances help in cleaning up and curing the tear or crack in the lining of anal canal due to fissures, ensure that the rectal tunnel gets relaxed and thus reduce the painful sensation.
• The enema, which is a method used to stimulate evacuation of stool, by injecting a liquid of medicated ayurvedic oil and ghee, helps in reducing pain, cramps within the region and swelling of the anal ring. This particular method of Panchakarma also ensures that the dryness of internal skin is reduced, thereby providing fast relief from the problem of fissures.

Anal fissure is a condition that is caused when the skin surrounding the anus tears due to excessive strain. Generally, constipation causes the condition, as people have to put a lot of strain during bowel movements. Here is a look at some simple ways to prevent anal fissure.

Natural Ways to Prevent Anal Fissure-
Since the primary cause for anal fissure is constipation, the preventative methods involve reducing constipation.

1. Increasing fibre content in the diet, with the help of fruits and vegetables can help against constipation.
2. Staying hydrated and drinking plenty of fluids throughout the day, can also ease stool passage and make it softer.
3. Avoid straining excessively during bowel movement.
4. Avoiding spicy foods and chillies in the diet is vital, as such foods can aggravate the difficulty during defecation.
5. Avoid eating excessive meat and non-vegetarian products.
6. Drinking buttermilk can also provide relief from the constipation.

Ayurvedic Remedy for Anal Fissure-
Medications for the condition include both oral remedies, which deal with the underlying constipation, as well as topical medicines that can be applied at the site of the problem. Two main Ayurvedic treatment for anal fissure include-

1. Kshar sutra ligation: In this specialized procedure, a string is attached around the affected region. However, before the string is tied, it is coated in a mixture of healing herbs and natural products. After the string is tied tightly, the benign tissue falls off after 5-10 days. The underlying tissue also gets repaired in a couple of weeks.
2. Sitz bath: Another easy and effective Ayurvedic remedy for anal fissure is to fill warm water inside a tub. Add a splash of antiseptic liquid in the water and sit inside the tub in such a manner that the anus and buttocks remain submerged in the water. This treatment reduces the pain and discomfort associated with the diseases and keeps the anus hygienic. 

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

Anal fissures arereferred to as a small cut or a tear in the lining of the anus. The cut or crack on the skin is the main cause of the severe pain. The person might observe bright red bleeding during and after passing bowel movements. Sometimes, when the fissure goes deep it exposes the muscle tissue underneath of the anus. An anal fissure might occur due to labor, i.e. during childbirth, straining or pushing during bowel movements, constipation, diarrhea, or certain medical conditions such as inflammatory bowel disease, cancer, and infection.

Individuals of all ages can be affected by anal fissure, including infants and young children. The common cause being constipation. This condition is not a serious issue. The tear can be treated or it might get heal on its own within a month or so. However, if it persists above two months, then it is considered a chronic or long-term fissure.

The symptoms of an anal fissure include:

• Visible tear or cut in the skin around the anus
• A small lump of skin or skin tag present next to the cut
• Severe pain in the area during a bowel movement
• Streaks of blood on stools or spotting on the dry tissue paper after wiping
• Burning sensation or itching in the anal area

Causes

Mostly an anal fissure occurs while passing very hard or large stools. This could be due to chronic constipation or frequent diarrhoeal episodes that can lead to tearing of the skin around the anus. Other causes of occurrence of an anal fissure are Crohn’s disease or inflammatory bowel disease, straining during labor, over tight or spastic anal sphincter muscles, or decreased blood flow to the anorectal area.
A fissure might also occur due to anal cancer, HIV AIDS, tuberculosis, syphilis, and herpes.

Treatment
Mostly anal fissure does not require extensive treatment. Some of the home remedies can help treat anal fissure and relieve the discomfort caused. The home remedies used for treatment are:

• You can use over-the-counter stool softeners
• Drink more water or fluids
• Take fiber supplements
• Have high fiber diets by including fibrous foods, such as raw fruits and vegetables, dry fruits, cereals, etc.
• You can even take warm sitz bath to relax and relieve the pain in the anal muscles and it will also help to increase the blood flow to the anorectal area.
• You can apply an ointment containing nitroglycerin to the anus in order to promote blood flow, or
• Hydrocortisone cream to help with healing the inflammation.
• You can apply topical pain reliever, lidocaine to the anus to relieve yourself from discomfort.
• An ointment with calcium channel blocker can be used to relax the sphincter muscles and will help to heal anal fissure.
• Botox injections into anal sphincter can also heal anal fissure. Spasms in the anal area can be prevented through Botox injections. This injection temporarily paralyzes the muscle. Due to this, the anal fissure gets time to heal and prevent the formation of new fissures.
• If the fissure is not treated with home remedies, the doctor might recommend anal sphincterotomy. This surgery involves making a small incision in the anal sphincter to relax the muscle, thus healing the anal fissure.

Prevention
An anal fissure can be prevented by taking following preventive measures:

• Keep anal area dry
• Proper cleaning of the anal area with mild soap and warm water
• Drink plenty of water and fluids to prevent constipation
• Avoid consumption of sharp foods that are difficult to digest such as nuts, popcorn, etc.

What do you mean by anal fissures? 
An anal fissure is a little laceration in the moist tissue that lines the opening of the anus. An anal fissure might develop as a result of a trauma. For example, a person suffering from constipation (or diarrhea) can develop fissure as a result of exerting too much pressure while defecating. 

Some of the symptoms of anal fissures include: 

1. Bleeding during defecation 
2. Defecation accompanied by a burning pain 
3. A persistent discomfort around the anus even after bowel movement 
4. Itching sensation 
5. In chronic case a small skin tag may be seen protruding out at Anal verge. Anal fissure causes considerable physical uneasiness and can mar one’s mood for days on end if left untreated. 

For someone who has recently developed this disorder, home remedies might work. 

1. Sitz Bath: This is a very effective self-care remedy that can ease the pain that anal fissure is characterized with. Here one needs to soak the rectal area in warm water for 10-15 minutes to help improve blood flow and relax the anal sphincter. The routine should be repeated 3 to 4 times for better result. 
2. Fiber-rich diet: Patients suffering from constipation shall consume fiber-rich foods like wheat, whole grain, fruits, oatmeal and cereals. 
3. Fluids: These patients must drink 8 to 9 glasses of water on a daily basis to induce smooth passage of stool. Medicines Medicines are prescribed only if self-care treatment methods do not work. 

Here is a list of the medicines that are used to treat anal fissures:

1. Stool Softeners are advised for easy evacuation for example Haritaki Churna, Triphala Churna etc. 
2. Soothing Ointments: Any soothing ointment like cow’s Ghrit, coconut oil or Sushruta Ointment if applied in anal region will ease out the pain. 
3. Kshar Karma: Application of specialized Kshar Compounds under supervision of an Ayurvedic specialist at weekly sittings lead to healing of Anal Fissure.

Surgery -

Most common complication of Surgery is stool incontinence where patient is unable to hold stool due to damage to sphincter muscles. Whereas Ayurvedic Ksharsutra is a completely safe and more effective treatment. In this treatment Ksharsutra is ligated at the root of Sentinel tag. Medicine released from the thread blocks the blood supply of tag and it sheds off in 5-7 days. This combined with Kshar Karma sittings heals the fissure completely without any surgery. In case you have a concern or query you can always consult an expert & get answers to your questions!

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!​

Anal Fistula - What Causes It? 
An anal fistula refers to a small infected tunnel connecting the anus to the outer skin. Your body eliminates solid waste products or feces through the anus. When any of the glands inside the anus becomes infected or blocked, an abscess may form, which in turn results in formation of anal fistula. In about 50% of the cases, abscesses develop into fistulae. What are the causes for anal fistula? Anal fistulae occur primarily due to the formation of an abscess or infection in the anus. If the abscess does not heal completely after the pus has been drained away, a fistula can develop. 

Other factors responsible for the occurrence of anal fistulae are- 

1. Crohn’s disease- a chronic condition where the digestive system becomes inflamed. 
2. Diverticulitis- an inflammation of the small pouches that develop along the intestinal walls. 
3. Hidradenitis suppurativa- a chronic painful skin condition which causes scarring and abscesses on the skin. Apart from these, people with HIV or infected with Tuberculosis disease also develop anal fistulae. If you’ve had a surgery around the anus, then post-surgery complications may lead to infection or abscess on the skin. 

What are the symptoms to watch out for? 
The commonly observed signs and symptoms of anal fistulae include- 

1. Irritation or discomfort on the skin around the anus 
2. Occasional throbbing pain, especially while seated, moving around or having a bowel movement 
3. Nodular swelling around anal region 
4. Intermittent Discharge of blood or pus from an opening near anal orifice. 

How does Ayurveda treat anal fistulae? 
Ayurveda recommends Ksharsutra treatment for complete healing of Anal Fistula.

In this procedure; Ksharsutra – a medicated thread is placed in Fistula tract. Medicine released from Ksharsutra debrides the fistula tract and induces healing. This medicine remains active for about 5-7 days so this thread needs to be changed with a new thread at weekly interval. No. of Ksharsutra changes required for complete healing of Fistula depends on length depth and branching pattern of fistula. It has been observed that Fistula heals at the rate of 0.5 to 1 cm per Ksharsutra changes so for a fistula tract of 3 cm length about 4-5 weekly thread changes are necessary for complete healing. Clinical trials conducted by Indian Council of Medical Research at AIIMS New Delhi have proved that Ksharsutra treatment is more convenient and more effective than Surgery in case of Anal Fistula. In this way Ksharsutra is the best way to treat Anal Fistula without Surgery. In case you have a concern or query you can always consult an expert & get answers to your questions!

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 its position inside the rectum or outside the rectum respectively. 

Causes: 

• Chronic constipation, where the person has to strain to pass stools 
• Increased frequency of motion as seen in dysentery etc. 
• Increased abdominal pressure like in pregnancy, obesity etc. 
• Smoking and genetics can also lead to piles. 

Symptoms: Starts off as painless bleeding, which happens in the form drops or blood spurts during bowel movement (1st stage); the swelling develops later on. They can continue to grow and may come out of anal canal while passing stool (2nd stage). Later on Pile mass comes out even on sneezing, coughing or standing for prolong time (3rd stage) 

Treatment: 

1. In the early stages, once identified, simple Kshar Karma (application of special medicines) is effective.. 
2. Diet should be rich in fiber, with fruits and vegetables 
3. Increased water consumption 
4. Ksharsutra Ligation of Pile mass if the disease has reached the 2nd or 3rd stage 
5. Prevention is advised if there is a family history by taking measures like consuming a fiber-rich diet and maintaining hydration, regular exercises. Sphincter exercise etc. 

Fistula: When an anal gland gets infected; it may discharge pus around the anal region or inside anal canal. Anal Fistula is characterized by presence of a nodular swelling around anal orifice with on and off discharges. This condition is usually painless however some pain may be noticed in the swelling before the pus discharges. After pus discharge pain and swelling disappears to recur again after some time. 

Symptoms: 

1. A constant wet feeling in the anal area, due to pus discharge. 
2. This would be intermittent, and there would be periods with no discharge. 
3. There could be a foul smell due to pus discharge. 

Diagnosis and Treatment: 

1. Identifying the exact location is important for Ksharsutra ligation or Surgery/ VAAFT. 
2. An ultrasound scan or an MRI is usually done. 
3. Ksharsutra ligation is a better option as compared to surgery/ VAAFT as the chances of recurrence after surgery/ VAAFT are very high. 

Ksharsutra being a non surgical procedure; is more convenient and more effective as compared to surgery. This has already been proved by the scientific trials conducted at AIIMS New Delhi, PGI Chandigarh etc. by Indian Council of Medical Research in 1990. 

Graded Ksharsutra is the latest development in Ksharsutra Therapy which is available only at Sushruta Ano Rectal Institute, New Delhi. 

Fissures: Fissure is a very painful condition produced due to cracks anywhere in the length of the anal canal usually at the anal verge. 

Symptoms 

1. Very painful and the person may not want to go to the toilet 
2. Rarely bleeding is also seen, maybe in very small amounts 

Treatment: 

1. Over 90% of the fissures do not require surgery and can be easily managed by Kshar Karma sittings. 
2. Switching to a high-fiber diet and improving hydration will help in managing these symptoms. 
3. Topical relief can be provided by application of medicated oils and paste. 
4. When they are recurrent, a procedure known as lateral sphincterotomy is done. However this procedure is known to have a common complication of fecal incontinence. This is usually seen due to damage to sphincter muscles during surgery or over stretching. Patient is not able to control / hold the stools. 
5. Anal fissure whether acute or chronic can be easily managed by Kshar Karma and Ksharsutra ligation. No surgery or hospitalization is required; and above mentioned complications are also not seen with this highly specific treatment of Ayurvedic surgery. 

Though one condition can lead to another, in most people, there is a strong family history 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! 

 Seeing blood in the toilet, on the outside of your stool, or with wiping after a bowel movement is common. Fortunately, most of the causes of such rectal bleeding are not life-threatening,common causes include hemorrhoids and anal fissures but rarely it can be due to serious diseases, so never ignore it . Consult your doctor timely. Most of the cases can be manged with medicines and diet modification rarely surgical intervention is needed.

Develop healthy eating habits to avoid constipation , drink plenty of water, take lots of fruits, salads, green vegtables. Avoid spicy oily food . Avoid or restrict Alchol, Smoking, Tobbaco , Caffeine .Walk and Excercise and always consult your doctor timely.

A tear in the anal canal is called anal fissure. When the skin breaks, it can cause pain and extreme discomfort. Some amount of bleeding during defecation may also be experienced. When the anal aperture is over-strained, it results in a crack leading to fissure. In women, delivery trauma can lead to anal fissure. Ulcer in the anal canal or sexually transmitted diseases too can cause the anal fissure. In children, it is commonly due to injury by passing hard stool. Fissure is usually seen at the anal verge. This being a highly sensitive area; any scratch or tear in this area gives excruciating pain, burning, itching, irritation like symptoms. There may be spasm in the anal region (which is a protective mechanism) and the patients are scared of passing stools. Sometimes patient avoids eating food so as to avoid going to toilet. Usually the pain subsides in an hour or so. However in some conditions where there is underlying inflammation and infection; the pain may persist whole day. Recurrent anal fissure which has not been treated properly give rise to an extra skin growth known as sentinel tag. 

Ayurvedic remedies: In the patient suffering from Anal fissure; it is very important to regulate the bowel habits properly. Some mild laxatives may be used to soften the stool. Hot sitz bath and use of some soothing ointments, coconut oil, ghee etc. are helpful as they avoid the irritation. Ayurveda can completely cure the people suffering from anal fissures. The treatment duration differs from one individual to another. This is also based on the severity of the disease. In acute anal fissure; the allopathic doctors usually recommend surgery. The commonest adverse effect of surgery is incontinence where the patient is unable to hold stools. However acute anal fissure can be treated without surgery very effectively using Ayurvedic Kshar Karma. In this therapy; certain medicines are applied in the anal fissure so as to promote the healing. The sittings are repeated after weekly intervals and fissure heals in 3-4 sittings. In this way; this is highly specific, very effective and convenient method of treating anal fissure. In chronic anal fissure with associated Sentinel tag; Ksharsutra ligation is used to remove the tag followed by Kshar Karma sittings. In case you have a concern or query you can always consult an expert & get answers to your questions!

If you think fissure and fistula are the same, you are mistaken. While the term fissure refers to the tear of the skin, fistula refers to the abnormal tube-like passages or connections between organs. Fissures get cured with or without treatment in a few days to few weeks, and do not lead to complications. On the contrary, fistulas when left untreated may lead to complications.

So, read on further to know about the distinction, how to recognize the symptoms and avail treatment.

What is anal fissure?
An anal fissure can occur due to various reason, such as prolonged diarrhea, anal sex, vaginal childbirth, rectum cancer, etc. For majority of the cases, it is usually due to constant constipation or strained bowel movements, that tear down the muscles controlling the sphincters to the inner rectum or the anal canal.

What is anal fistula?
Anal fistulas are not tears but abnormal abscesses near the anus, filled with pus. In fistula, a tunnel is formed under the skin which connects these abscesses to the infected glands. Fistulas are usually the results of present or previous abscesses. If ignored or left untreated, one single fistula can lead to the development of a more complex fistula, where the single fistula tract ends up creating multiple openings.
 

Symptoms of anal fissure and anal fistula
Some of the common symptoms of an anal fissure are excruciating pain in the anal area every time the bowel movement occurs, constant itching or burning sensation in and around the anus, bloody stool and visible tears and cracks around the anus.

For anal fistula, some of the very common symptoms are a throbbing pain in the anus, which continues to increase, difficulty in sitting down for longer period, swelling and redness around the anus, accompanied by skin irritation, discharge of blood and pus, and at times fever.

Treatment options
To completely cure anal fissure and fistula, it is the various surgical options that are the most effective ones. However, when diagnosed in its earliest form, medications like antibiotics, analgesics, and antipyretics can often help. It is solely depending on the location, type, and size or severity of the fistula or fissure, the treatments may vary from person to person and so does the recovery time.

Though, these conditions cannot be cured with dietary changes or exercise, following a healthy diet can boost healthy bowel movement, reducing chances of constipation or diarrhea that results in fissures.
Prevention is always better than cure. Therefore, it is essential that you visit the nearest medical facilities once you notice any signs of fissure or fistula , to avail the right treatment and get relief from the symptoms quickly. In case you have a concern or query you can always consult an expert & get answers to your questions!