Fissure in Ano and Everything to Know

What is an Anal Fissure

It is one of the most commonest conditions that my patients come to me with.
It is usually the First problem that starts, due to a hard stool making its way through the sensitive, soft Anal Canal.
Soft Stools are squeezed by the Muscles involved in Defecation and all is well
The issue starts here when the hard stools are forced out of the Anus. Due to this forcing out, a tear may occur either in the outer mucosal layer (Skin like region) and can go all the way to involve the Sphincter Muscles.
It is one of the most painful conditions and it is know to make my patient’s lives very difficul

Is it a Painful Condition

Yes it is one of the most painful conditions that can happen in the Peri-Anal Region
It Starts with a severe knife like sensation while passing stools, some patients are even known to pass out due to the pain.
It can persist all throughout the day and can ruin a patients day. A painful poop means a bad mood throughout the day, leading to issues at work, in personal relations, performance etc
If patients approach me timely, I can vouch that the issue will settle down soon after starting your personalised treatment and surgery may be avoided.

Can Anal Tear be treated by Medications and without Surgery?

Yes, most of the Fissures can be treated only by medication and lifestyle changes
Fresh (Acute or New) fissures are best suited for Non-Surgical Methods of treatments
In my experience the best opportunity or the Golden Period for the Fissure to be treated by Medication is to visit Dr Parth Gajjar as soon as possible
Majority of the Fissure patients come at a later stage because they feel shy to share their problems
However “Jab se Jaage, Tab Se Savera” (The Day Starts whenever you wake up!) , and i encourage all my patients to not procrastinate and come for consultation as soon as possible

What are the most common causes of Anal Ulcer

The Single Most Important factor for your Fissure is: Lifestyle
A low fibre diet, with high amounts of processed foods is bound to lead to hard stools which in turn cause Fissures
High Pressure Jets/ Bidet are also known to cause Anal Ulcers
Anal Sex, without proper preparation and knowledge, is also know to cause Anal Tears
Other Causes like Local Fungal Infections, Itching, Anal Warts etc are also responsible for Anal Fissures
My patients should not hesitate even for a moment before coming for consultation and share the entire history properly

How to Treat Fissures at Home

Fissure Treatment can start at home by drastically changing your diet.
Include atleast a large bowl of Salads with every meal (Breakfast Lunch and Dinner)
In Between Meals, try to eat as many Fruits as you can instead of snacking on Biscuits, Namkeen, etc
Sitting in a Warm water filled Tub, better known as Sitz Bath, helps relieving pain and the muscle spasm that is happening due to the pain
Local application of ointments like Lignocaine 2% Jelly helps lubricate the Anal Canal and also helps in reducing the pain.
Softening of Stools or cessation of Anal Sex so as to stop the triggering mechanism and giving the body enough time to Heal, is of prime importance for treatment of any Ano-Rectal Diseases
Try and avoid using Jet Sprays

Why Do I have Anal Tears?

Relax, Nature has not singled you out for having Fissures, nor is having Fissures Genetic.
Primarily it is a lifestyle disease and the majority of the patients can make moderate changes in their habits and the Fissure might even heal by itself

How does standing up help if there is so much of blood?

If you try to observe the bleeding, you are going to stretch the Torn tissue even more and exacerbate the Fissure
Cotton acts as a trigger for clotting to initiate and by standing up, both the legs coming together, gives compression to the Injured area.
Staying in such a position, even walking around is possible, for 10-15 minutes will stop the bleeding
However,I request you to not observe the bleeding as trying to do so will stretch the Fissure apart and make you bleed further more by dislodging the clot that has formed.

What are the Consequences of Blood Loss due to Anal Ulcers/Fissures

Yes, it can be very frightening to see bleeding per anum (Hematochezia in medical terms), it is not as grave a condition as you might fear thinking about
Most of the times the bleeding is described as “drops of blood” and when these drops of blood mix in the water, it seems like it is a lot of blood.
However, if the Tear extends all the way up till the Muscle, then one should expect higher amounts of blood.
In Such a situation, after stools are passed and the area cleaned
First thing to do is not panic and just place a clean cotton gauze piece or cotton cloth.
After placing the cotton right outside the Anus, one should simply put the clothes back on and stand up instead of trying to observe the source of the bleeding and amount of damage

Doesnt so much blood loss damage my body?

If the Fissure has been bleeding regularly over a long period of time, then that is likely to get you to have Anemia, ie reduced Hemoglobin in your body.
A bleed due to Hemorrhoids (Piles) can be profuse and is described as a “Gush of Blood” instead of “Dripping of Blood).
Hemorrhoidal Bleeding is heavier and needs to be addressed immediately.
Either ways, Oral Hematinics or Intra-Venous Hematinics can be administered to correct the blood loss.

What is a Sitz Bath?

Sitz Bath is when you immerse your Bottom into lukewarm water so as to relax the Anal Sphincter and give relief from pain.
Sitz Bath Tub can be bought from the e-commerce websites like Amazon and Flipkart, by simply searching “Sitz Bath Tub”
It is a very convenient way to do sitz bath specially for those who are Pregnant, Elderly, Obese, or have Knee and Joint Issues.

What is the Diet to Follow to Cure Fissure in Ano?

Fibres are the most important content that you should have in your diet.
Salads, Fruits, Green Leafy Vegetables, Sprouts, Dry Fruits etc are known to be very rich in Fibres
Foods that should be avoided are all kinds of processed foods, specially Maida, Deep Fried or Oily Foods, Spicy and high fatty content foods.
atleast 3-4 Lts of Water and other natural liquids are absolutely essential to keep the stools soft
The Fissure shall start healing only if the soft stools are sustained over a long period of time. Even one incident of Hard Stools can upend the Fissure Treatment and you shall have to start the treatment from the beginning.
Although Benign, Fissures if not treated timely, may lead to other conditions like Hemorrhoids (Piles), Fistulas, Ano-Rectal Abscesses, Ischio-Rectal Abscess and many other problems
A Chronic Fissure, having a sentinel pile, is less likely to be treated by medications and might need Surgery

How long does it Take to treat a Fissure with Medication?

In any Injury of the body, the triggering factor has to be removed followed by giving the area some rest so that the body can heal the injury, that is why we do dressings, or wear bandages, or casts, or braces etc
However, there is only 1 Anus that the body has and it is going to be used everyday (I do have had patients who had stopped eating so that they would not have to go pass stools)
It depends on the gravity of the Tear that has received how long the Fissure will take to heal.
A Patient has to typically continue maintaining Soft Stools and application of local ointments for a period of 1-3 Months
A Lifetime full of soft stools has to be ensured so that the injury does not happen again.

What are the non-surgical methods possible if my Fissure Fails to Heal?

Sometimes, a long standing Fissure (Chronic Fissure) or a very Deep Acute Fissure might fail to heal medically.

In such cases, Non Surgical methods like Botox Injections are highly helpful, but recurrence of the Fissure after the effects of the Botox die down is seen commonly

In such cases, the Botox injections have to be re-administered

Botox injections are good for a period of about 2-3 years

Other Methods of Healing are also present non surgically, but due to the high recurrence rate, those methods are not acceptable now a days

What types of Surgeries can be done for Fissure in Ano

Surgical methods available are either of the 2:

Conventional (Open/Closed)
Recent Advances (Laser or Minimally Invasive)

What is a Conventional / Open Fissure Surgery?

An Open Anal Fissure Surgery, also called Open Lateral Internal Sphincterotomy, involves keeping an incision over the Skin and reaching the Sphincter muscle, and keeping a small incision on it to relax the spasm of the muscle.
In this method, the Sphincter Muscles is given a destressing incision directly under vision and is considered a very safe method, although very, very painful postoperatively

What is a Conventional Closed Fissure Surgery?

A Closed Anal Fissure Surgery, also called a Closed Lateral Internal Sphincterotomy, Involves place a small entry wound over the skin and an instrument (Artery Forcep) is inserted and a small portion of the Sphincter Muscle Fibres are Hitched Out and excised
It is a blind procedure and unless performed by experienced hands, is a risky procedure as it may involve heavy post-operative bleeding and improper estimate of the thickness of the Internal Sphincter may lead to incontinence

What is a Laser or a Minimally Invasive Surgery for Fissure in Ano?

In a Laser Surgery for Fissure, under the effects of Spinal Anesthesia, a small Laser Fiber of about 0.7 millimeters diameter is used.
A hole of the same size is made near the Sphincter Muscle and a portion of the muscle fibers are ablated.
The Light emanating from the Laser gives the surgeon a precise idea of the amount of the sphincter fibers that are being ablated, ie under direct vision, so it is a very safe surgery
There is no bleeding encountered and there is no need for any dressings.
Pt can be discharged on the same day after the effects of Anesthesia wear off.
Majority of my patients are known to have rejoined work the day after their discharge
Most of my patients feel that the postoperative pain was much less than the pain they underwent before the surgery
Many patients travel from different states, get operated and go back to their hometowns immediately after discharge and the remaining follow up is done through phone or video conferencing

Why is Laser Fissure Surgery the Best?

It preserves the Anatomy of the Anal Canal as best as possible

It is the method with has the minimum painful and maximum proven and established results

Sometimes even the patients are surprised post surgery, and do not believe that such a remarkable surgery was possible!

Is it true that there is a loss of control after surgery?

A temporary period there might be decreased functionality of the anal sphincter and some patients do experience mild leakage, but the patient recovers from that issue within a week

It is a very commonly asked question about patients who have had lost the entire control mechanism.

It is very much possible if unqualified doctors, inexperienced surgeons, or worse, Quacks, perform Laser surgeries, they can do a lot of damage due to the powerful machine

A Fool with a Poweerful Tool is a very Dangerous Fool.

I have encountered many such suffering patients and have also performed corrective surgery on them and helped them regain Bowel Control.

If anyone is known to you who is suffering from such a post-operative problem, then please do refer them, I can improve their quality of Life,

Click Here to know how to research well into the qualifications of your Doctor

What to expect after Piles Surgery?

There are many online patient aggregators who give false hope to their patients that the surgery shall be painless.

However, it is wise to know that no matter how good a procedure is performed, the human body is going to react in the natural ways that it has been reacting since centuries

If the patient decides to get operated when he is having severe pain, I assure them that the pain after Laser Fissure Surgery will be less than the amount of pain that you came to me with.

Post-operatively, the muscle shall be in a surgical shock and hence its functioning will be impaired, it is nothing to worry about as most of the functionality returns within a week

You will be advised exercises after a period of time so as to improve the functionality of the controlling muscle.

Other things that should be expected is Bloody Discharge, as Laser Surgeries tend to have no cutting but instead the tissue dies and is then flushed out of the body in the form of Bloody Discharge. This shall also subside within 7 to 10 days post surgery.

Flatus / Gas control will be the last to come but be assured, that every patient regains control within a few days of the surgery.