Fissure in Ano
What is an Anal Fissure
- A Fissure in ano is one of the commonest conditions that patients come to me with.
- The First problem that starts, due to a hard stool making its way through the sensitive, soft Anal Canal.
- Normally, Soft Stools are squeezed by the Muscles involved in Defecation to evacuate the stools.
- The injury starts when hard stools are forced out of the Anus.
- A tear may occur in the outer mucosal layer (Skin like tissue) and can go all the way to involve the Sphincter Muscles.
- One of the most painful conditions and it is known to make patient’s lives very difficult
Is it a Painful Condition?
- Yes it is a very painful condition that can happen in the Peri-Anal Region
- Starts with a severe knife like sensation while passing stools, some patients are even known to pass out due to the pain.
- Can persist all throughout the day.
- Beginning the day with so much pain can disturb other areas of a patients life, like work, personal relationships, other activities.
- If patients approach 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 treated by Non-Surgical Methods of t
- The Golden Period for the Fissure to be treated by Medication is to visit 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!)
- 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(Fissures)
- 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 arises out of fissures.
- Local application of ointments like Lignocaine 2% Jelly helps lubricate the Anal Canal and also helps in reducing the pain.
- Softening of Stools so as to stop the triggering mechanism and giving the body enough time to Heal, is of prime importance for treatment of all Ano-Rectal Diseases
- Try and avoid using Jet Sprays (Bidets) while the treatment is ongoing
- Anal Sex is also a known cause for causing Anal Fissures.
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
- Families may have larger Sphincter Muscles that might make people of the same family more prone to Fissures
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.
- Have encountered some patients who entirely stop eating due to the pain due to the fear of passing stools
- What is important is to start ensuring you start passing soft 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.
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
Botox injections have to be re-administered after a period of 2-3 years
Other Methods of Healing are also present non surgically, but due to the high recurrence rate, those methods are not applied in clinical scenarios
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 there a loss of Sphincter 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 completely painless and magical.
- 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.
FAQs
How Long Do Anal Fissures Take to Heal?
- Healing of a Fissure can take from about 14 days to forever
- Having Soft Stools is of Primary Importance for your Fissure to start its recovery journey.
- Maintaining the Soft Stools such that there is not a single episode of hard stools that might end up disturbing the process of healing of the Fissure
- Surgical Treatment is the fastest way of treating Fissures, specially with the advent of Lasers.
- Anyone who has been having repeated Fissures and suffers from these troubles every now and then, should heed my advice and believe that only surgery can give them a permanent relief!
Signs You Might Have an Anal Fissure: What to Look For
- Initially the most notable sign that you might face is a severe knife like stabbing pain that you will feel while you clean ur bummy after pooping.
Sometimes you might end up immediately standing up from the pot.
It is because the Jet Spray hit you exactly where the Fissure was.
Although this knife ike pain is the most notable complaint, pre-fissure a patient might feel “some” discomfort.
Perianal burning sensation is also felt by the patients. This sign precedes the Knife like pain due to the bidet or jet spray.
it happens because the hard stools end up creating micro-abrasions, ie, small microscopic scratches on the skin, that lead to the burning sensation, specially post pooping.
advanced fissures will also accompany droplets of blood during or after the defecation period.
occasionally you might also find blood stains in your underwear.
Hallmark for anyone having a fissure is PAIN.
The person starts his day with and then has to go through pain all throughout the day.
Patients social relationships as well as professional relationships might be affected due to the pain that one suffers!
Best Ways to Heal a Fissure Fast at Home
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What Does Fissure-Related Bowel Movement Look Like?
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How to Know Your Fissure Is Actually Getting Better
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When Do Anal Fissures Require Surgery?
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Is It a Fissure or Something Else? How to Tell the Difference
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Serious Fissure Warning Signs You Shouldn't Ignore
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Foods to Avoid When You Have an Anal Fissure
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Best Over-the-Counter Treatments for Anal Fissures
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How Much Fiber Do You Need to Heal an Anal Fissure?
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Sitz Baths for Fissures: Do They Actually Work?
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Chronic vs Acute Anal Fissures: What's the Difference?
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Recovery Timeline After Anal Fissure Surgery
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Difference between acute and chronic fissures
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Children and anal fissures: Special considerations
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