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Anal Fissure

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What is an anal fissure?

Anal fissures are characterized as skin cuts or tears that occur within or around the anal region. Some of its possible side effects include extreme discomfort and red blood stains in the stools. Fissures are known to afflict people of all ages, however, they continue to be more prevalent in young children or middle-aged people.Often, fissures can be removed at home and don’t necessarilypose a health issue.

In less severe situations, stool softeners or certain painkillers may be helpful. However, if that does not work, the only resort would be surgery.

Courtesy: Memorial Sloan Kettering Cancer Center

What are the signs and symptoms of a fissure?

A patient with anal fissures could exhibit one or more of the following signs or symptoms:

  • Noticeable tear around the anal area.
  • Cracking or lumps/tags in the skin around the anus.
  • The feeling of burning and itching in the anal area
  • Pain during bowel movements.
  • Blood stains on stools.
  • Muscle spasm in the sphincter
  • Discharge with a foul odour.

What are the different causes of fissures?

Abrasion of the anus lining is the most frequent cause of anal fissures. Other common causes include:

  • Passing large or hard stools
  • Strained Bowel Movement
  • Continuous Constipation
  • Prolonged Diarrhea
  • Anal Sex
  • Rectum Cancer
  • Vaginal Childbirth

Less common causes of anal fissures include Crohn’s disease, bowel conditions, pregnancy, anal cancer, HIV, tuberculosis, herpes, and syphilis.

Risk Factors for Anal Fissure

People of any age or gendercan be affected by anal fissures.  However, infants and older people are more prone to the condition. Most babies experience an anal fissure during the first year of their life. The sight of bright crimson blood in faeces and toilet paper may disturb some kids.

Anal fissures often heal on their own, without the need for intervention from a doctor or surgery. OTC medicines and topical creams, suppositories, or both, may help with symptoms. Some individuals may have persistent issuesif the lesion doesn’t heal properly.

Acute anal fissures are those that persist no longer than six weeks. The symptoms of a chronic anal fissure last for more than six weeks. A secondary anal fissure has a cause that can be identified, however, a primary anal fissure does not.

Prevention of Anal Fissures

As previously mentioned, various circumstances can cause anal fissures to develop. Even if they can’t always be avoided, the risk of acute or chronic anal fissures can be decreased by taking the following precautions:

  • Keeping stools soft:Maintain soft stools by eating a well-balanced diet rich in fibre. Consuming lots of fluids like water and fruit juices can also significantly reduce the likelihood of recurrent anal fissures.
  • Avoid bathroom delays:Don’t put off going to the toilet since larger, firmer stools will eventually emerge if the patient waits.
  • Changing Baby’s Diapers: Changing babies’ diapers frequently at regular intervals might lower their risk of getting anal fissures.In order to prevent irritation and itching, keep the baby’s anal area clean and dry.

Courtesy: Lybrate

  • Sharp foods:Stay away from foods like popcorn and nuts that are hard to digest.
  • Wiping the anal area:The anal region should always be kept dry. As soon as the area of the stool is cleared and cleaned with water, be sure to dry it off with a fresh towel. Also, wiping with cotton pads or damp rags after using the restroom can be helpful as well. Avoid toilet paper that is scratchy or scented.
  • Wash regularly:The skin around the anus area is quite delicate. To keep bacteria and germs at bay, routinely wash the region with a bar of mild soap and water.
  • Exercising Regularly:Regular exercise can lower the risk of constipation, which lowers the likelihood of developing anal fissures. Drink plenty of water both before and after working out.
  • Avoid straining:Avoid straining and spending a lot of time on the toilet.

Diagnosis& Tests for Anal Fissures

After performing a physical examination of the anal region, a doctor can usually identify an anal fissure. The anal region is thoroughly and broadly examined as part of a physical examination because it is all that the doctor needs to confirm the presence of an anal fissure before moving forward with diagnostic tests.

Anoscopy: During this procedure, a tiny tube is put inside the anus to provide the physician with a clear view of the rectum and anal region.

Colonoscopy:A flexible tube is inserted within a patient’s rectum during a colonoscopy to provide the doctor with a view of the whole colon. This test is usually performed when a patient is over 50 and at risk for colon cancer.

Flexible sigmoidoscopy: This test is carried out if the patient is under 50 and has no risk factors for colon cancer. To provide the doctor with a clear view of the inside, a lengthy, flexible, and thin tube is put inside the rectum.

Rectal Exam:A gloved finger or other tiny tool is inserted into the rectum during a rectal exam. The doctor will typically refrain from doing this, though, as it might be too painful. Prior to a rectal exam, a doctor may anesthetize the area.The patient will be referred to a specialist if the doctor thinks there might be something more serious going on.

Fissure Surgery

According to studies, surgery is by far the most effective treatment for chronic fissures. The doctor could advise surgery if a chronic anal fissure is unresponsive to other therapies or if the symptoms are severe. When it comes to anal fissures, there are two different sorts of surgeries that are carried out.

  1. Lateral Internal Sphincterotomy (LIS):The lateral internal sphincterotomy (LIS) operation is often done by doctors. A tiny section of the anal sphincter muscle is severed during LIS. This method might facilitate healing while easing pain and spasm.There are two methods for carrying out this procedure.When performing an open sphincterotomy, the doctor makes a little incision in the patient’s skin to expose the sphincter muscle and then leaves the wound unbandaged so that it can heal. The doctor will perform a closed sphincterotomy to access the muscle and sever it. For anal fissures, this kind of surgery is incredibly helpful.
  2. Anal Advancement Flaps:In this surgery, the surgeon removes a healthy section of skin and replaces it on the fissure area’s damaged skin. The surgeon might suggest this surgical approach if the patient is likely to experience incontinence after surgery.The advancement flap is one of the most common and traditional surgical techniques.

Fissure Prognosis

In conclusion, fissures can be uncomfortable and embarrassing even though they may not be life-threatening. Among kids, it’s rather frequent, and they usually respond well to treatment.Anal fissures may be treated at home with the right medications and dietary adjustments. Having a discussion with a healthcare professional can put the patient on the proper path. Doctors may choose surgical procedures if medications fail to work.Therefore, receiving the right medical advice is crucial and strongly advised.Although, most people recover from it without any problems.