Anal fissure Totally Explained

Everything about Anal Fissure totally explained

An anal fissure is an unnatural crack or tear in the anus skin. As a fissure, these tiny tears may show as bright red rectal bleeding and cause severe periodic pain after defecation. The tear usually extends from the anal opening and located posteriorly in the midline. This location is probably because of the relatively unsupported nature of the anal wall in that location.

Causes

Most anal fissures are caused by stretching of the anal mucosa beyond its capability. Many acute anal fissures will heal spontaneously. Some fissures become chronic and won't heal. The most common cause for this is spasm of the internal anal sphincter muscle. This spasm causes poor blood flow to the anal mucosa, hence producing an ulcer which doesn't heal since it's deprived of normal blood supply. Anal fissures are common in women after childbirth; following excessive anal intercourse; after difficult bowel movements; and in infants following constipation.

Prevention

In infants under one year old, frequent diaper change can prevent anal fissure. For adults, the following can help prevent fissure:

Treating constipation by eating food rich in dietary fiber, avoiding caffeine (which can increase constipation), drinking a lot of water and taking stool softener.
Treating diarrhea promptly.
Lubricating the anal canal with a water-based lubrication before inserting anything into the anal canal (petroleum jelly isn't recommended because it can harbor harmful bacteria).
Avoiding straining or prolonged sitting on the toilet.
Using a moist wipe instead of perfumed and harsh toilet paper.
Keeping the anus dry and hygienic.
When using Analpram (cream) don't use the dispenser which can injure the area. Instead use a finger to insert a pea size amount of cream.

Treatment

For many years up until 1995, customary treatment included warm baths, topical anesthetics, stool bulking agents, mechanical anal stretching, and, sometimes, surgery. in 1999 with nifedipine ointment, and the following year with topical diltiazem. Branded preparations are now available of topical nitroglycerine ointment (Rectogesic as 0.2% in Australia and 0.4% in UK) and diltiazem 2% (Anoheal in UK although still in Phase III development). Botulinum toxin injection, administered by colorectal surgeons, can also be used to relax the sphincter muscle and its use for this condition was first investigated in 1993. Combination of medical therapies may offer up to 98% cure rates, These medical treatments are used as first line therapy in treating chronic anal fissures, although a Cochrane Collaboration review of published research has questioned the effectiveness of medical treatments compared to surgery.

Surgical sphincterotomy

Surgical intervention may be required for persisting deep anal fissures unresponsive to the above conservative measures. Procedures include:

Internal lateral sphincterotomy or excising a portion of the sphincter

Anal dilation or stretching of the anal canal is no longer recommended because of the unacceptably high incidence of fecal incontinence. In addition, anal stretching can increase the rate of flatus incontinence. Despite the high success rate of these surgical procedures (~95%), there are potential side effects, which include: risks from anesthesia, infection and anal leakage (fecal incontinence).

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