Anal fissures
The cracks or tears produced around the anus margin in between the rectum, on the muscle responsible for controlling the bowel movements are called as anal fissures. Around the anorectal area, fissures can become a reason for severe pain. Due to the sensitive location, they tend to get aggravated because of bowel movements. The pain may end within few minutes for most people, while it can last for hours for others. Small amount of discharge and blood may also be noticed from these fissures. Mostly, anal fissures are a result of diarrhea or constipation. Some fissures occur due to increased muscle tone of anal sphincter. Fissures may occur in combination with anorectal problems like fistulas and hemorrhoids. Crohn’s disease (chronic inflammation in colon) or other inflammatory problems may result because of multiple, large anal fissures located atypically. Symptoms similar to anal fissure may also result from certain rectal and anal cancers. Therefore, careful examination becomes necessary before confirming the disorder.
Early treatment mostly heals the fissures within few weeks. Clinical treatment coupled with a high-fiber diet, stool softeners, sitz baths, medicated suppositories, and laxatives may help in healing many superficial fissures. Cauterization and curettage is an in office treatment that involves stimulating the process of healing by applying chemicals over the anal fissure. These treatments may be needed after every 3-4 weeks. To prevent and heal fissures constipation must be controlled. A fiber rich diet should be given to the patient despite the absence of symptoms. Addition of a bulk laxative i.e. psyllium products to the diet helps in prevention of recurrence. Plenty of water must be had to gain the benefits from psyllium products. Laxative preparations which contain mineral oil are not used because of difficulty in cleansing of the area after defecation. Many patients may gain help by decreasing the tone of abnormal anal sphincter by using a variety of topical medications available.
Many fissures heal but recur later. Repeated recurrences lead to scarring (damaging the anal sphincter) and narrowing of anal canal. Surgery may be required in case the problem does not heal even after office management treatments or in case of pain, narrowed anal canal or infection due to a deep acute fissure. About 30 % of patients require surgery. Early diagnosis may not require surgery for curing and treatment, however it helps in avoiding complications such as scarring, infections, and narrowing of anal canal.
CO2 laser cauterization (requiring sedation and on outpatient basis) abolishes the spasm in anal sphincter and heals, where the patient can begin normal activity from next day. Partial internal sphincterotomy and fissurectomy may become necessary in sever cases where all other non operative measures fail. Patient may need at least a week’s rest to recover.
Written by admin on April 30, 2011 under Proctology.
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