What is an anal fissure?
This is a very common Anal fissure disease causing a lot of suffering to the patient. It consists of a tear or a crack in the skin lined part of the anal canal. It usually found in young and middle age people but sometimes even in children. Though a small crack, the pain and suffering inflicted by it is of great magnitude. Besides, more often than note, it doses not heal permanently and keeps on showing its effects continually or intermittently.
The crack is usually in the midline posterior i.e. in line with the left of the buttocks. Occasionally it may be in the front or sides ie anterior or lateral. Sometimes a little tag; swelling of the skin develops at the edge of the anus. This is could the sentinel tag or Sentinel Piles. This stays even after the fissure heals unless excised.
Very long standing fissure develops hard fibroid tissue. Later on, perennial abscess or an anal fistula may form as a complication. Fissure in Ano is also a common cause of anal stenosis / spasmodic anus.
Causes of Fissure in Ano
The causes of the fissure are not very clear. Rarely fissure is cause due to some bigger underline problem like chrons, Ulcerative colitis, Tuberculosis, Growths etc. The other main possible region could be trauma to the area due to a passage of unusually hard stool. Patients often tend to take laxatives for getting a soft watery stool, thinking that this will not cause them pain and will solve the problem. It is true that such patients will note face the problems (Pain, temporarily) avoiding the necessity to expand or stretch anal canal / anal orifice, but ultimately this leads to more contractions of the canal. Hence, after sometimes this patient face difficulty in passing even normally formed stool.
Spasm of the anal sphincter (Valve of the anal canal) and ischemia (insufficient blood supply to the area) may be the helping factors in the development of fissure and also in preventing the healing process.
The internal sphincter plays an important role in the development of a Fistula in Ano. These muscles, controlling the opening of the anus, can not be control voluntarily. Pain due to the fissure will cause spasm of the internal sphincter and not allowed it to relax.
• Pain: This is the most predominant symptom of a Fistula in Ano. It is often described by the patient as of sharp, cutting searing and tearing nature & is of great severity. The pain is usually during defecation and may last up to three to four hours after defecation. The Pain is so agonizing that the patient dreads his visits to the toilet and tends to avoid passing stool, as a result in some cases remains constipated for several days. This further aggravates the symptoms when he eventually has to pass stool.
Some patients discover that by passing soft watery stool, the pain can be avoided and develop a habit of taking laxative / purgatives regularly instead of getting proper medical advice. These patients unknowingly are actually aggravating the problem by worsening the condition of the sphincter.
• Bleeding: There may be Fistula in Ano without bleeding but usually, the pain is accompanied by bleeding during defecation it is bright red appears as a speaker along with the passage of stool. Occasionally it may be profuse-heavy.
• Swelling: Most patients develop a skin tag ( a lump) due to the swelling of the skin at the site of the fissure
• Discharge & Priorities – Anal itch: Occur usually in chronic cases and leaves the patient very uncomfortable.
• Urinary problems: Some long-standing cases of painful fissure develop disturbances in a passage of urine, some times the frequency to urinate is increased whereas in some cases there is retention.
Condition of the Anal Fissure
Fissure can be categories as acute and chronic.
Acute Fistula in Ano are those which have developed recently ( Less than about 5 weeks) these may heal spontaneously.
Chronic anal fissure is comparatively long-standing fissure more than 5 to 6 weeks these fissures will usually not heal without professional care.
When to see a Doctor?
When the symptoms persist for more than five weeks or if the pain is severing or the bleeding profuse one should seek medical advice.
Correcting Constipation: Correcting constipation is very essential. It is necessary to set up a regular pattern of passing stools. This can be done by adopting a high fiber diet, not only till the fissure heals bur permanently to avoid recurrence. A high fiber diet may be supplemented by taking bulk-forming agent when & where required. (Proctolaxee)
Local Anesthetics are effective to reduce patient should not be used over prolong periods(Proctoheal)
Sitz Bath: The best way to reduce pain is a sites bath in simple warm water or warm medicated water (Proctobath)
Conservative treatment of Anal Fissure:
Ayurveda offers conservative treatment for an acute anal fissure, for some not so chronic fissures where the operative procedure has to be temporarily avoided or prolonged due to a various region, for infants and aged patient or where there is a risk of surgery/anesthesia.
Classical texts of Ayurveda like Sushruta & Charak etc advocate the use of many herbal combinations both oral & topical for the treatment of Fissure in Ano. In our experience of over 20 years, we have taken clinical trials of a number of these combinations and have developed a few very effective combinations to treat this condition.
• ProctoLaxee powder – A unique combination of bulk-forming herbal agents & other precious herbs that help to establish regular bowel movement. These herbs are also storehouses of natural antioxidants and have Rasayana (rejuvenation & longevity promoting) property
• ProctoHeal oil (Topical): This unique Ayurveda formula ( Medicated oil) is introduced into the anal canal ( 15 to 20 ml) daily for 7 to 10 days before going to bed. It helps to heal the anal fissure and significantly reduces the pain & spasm.
• Proctobath powder/tab (Topical): This is a time-tested Ayurveda – herbal combination slightly modified to suit your specific needs. Added to the warm water for the sits bath it provides quick and significant relief from Pain, burning & swelling in the anal – perennial region. It also helps to check infections, controls discharge and Anal itch -pruritus.
• Anal dilators: use of anal dilators of varying size is helpful. The dilator is lubricated and gently inserted into the anal canal ones a day after defalcation & sits bath for 7 to 15 days.
Surgical and Para Surgical Procedures
• Anal Dilation: Dilation of the anal canal is a short procedure whereby anal canal is manually dilated. This is also called Lord’s anal dilatation.
• Sphincterotomy: This involves cutting the anal sphincter. In some cases, the patient may develop partial incontinence (Inability to control wind or stool after surgery. However, in most cases, this is a temporary condition and improves with time. Methods of sphincterotomy may vary (internal sphincterotomy, Posterior internal sphincterotomy, Lateral sphincterotomy).But we have expertise in unique Closed Tailored Lateral Internal sphincterotomy with Cataract Knife (CTLIS) with minimal pain and minimal scar(within millimeters) without the fear of fecal incontinence and complication.CTLIS with cataract knife is practicing only a few centers across India.
• Fissurectomy – Surgical removal of anal fissure
Fissurectomy if done in a conventional way may need hospitalization for a couple of days.But in Ayurvedic treatment, there is no need of this fissurectomy. We are using unique PRATHISARANIYA THEEKSHNA KSHARA; a potent Ayurveda preparation to heal the fissure-bed soundly within days.