Fissure-in-ano: Introduction

Anal fissures, also medically called as Fissure-in-ano, is nothing but a painful conditions where there is a longitudinal cut on the skin of anus. Due to friction or scratch or trauma, there may be a cut or fissure formation. Males, females including adults as and children may get affected with Fissure-in-ano.

The rear part of anus is a common spot affected due to poor blood supply, leading two formation of fissure and difficult healing. Some conditions such as constipation, chronic diarrhea, ulcerative colitis, Crohn's disease, etc. could trigger or lead to fissure formation.

Common Symptoms of Fissure-in-ano

01 Pain while passing motions: Painfulness of the anus where there is a cut, is the most common symptom. The pain typically described by the patient is as cutting, shooting, agonizing, burning or even excruciating. It may last for a few hours after passing stool due to friction, fresh trauma, inflammation and infection. It would start soon while passing stool, at times, preventing the defecate. Children may avoid passing stool due to anticipated pain. If patient has consumed spicy food, there could be burning while passing stool; and afterwards. The pain may subside after a few minutes or few hours; to re-appear after the next call for passing stool.

02 Severe anal spasm (as a protective reflex)

03 Hard stool may cause friction on the wall of anus giving blood streaked stool. There may be frank bleeding after passing stool, which is likely to be bright red in color.

04 Itching, Discharge, swelling are common symptoms of chronic fissures.

Causes of Fissure-in-ano:

Most common cause of the fissure-in-ano is constipation. Chronic constipation due to any reason (such as due to lifestyle, habitual, drug induced, due to pregnancy, etc.) leads to recurring abrasion or forceful rubbing of the anal mucosa, which leads to a fissure. The current theory also suggests that sphincter spasm and accompanying ischaemia ;may precipitate the development of fissures and prevent them from healing in some people. The other less common causes can be

• Following a bout of diarrhea or following passage of bulky or hard stools (especially in children)
• Multiple pregnancies
• Chronic use of purgatives
• Rarely, a fissure may be the manifestation of underlying disease e.g. Crohn's disease, ulcerative colitis, sexually transmitted disease, or cancer.
• Wrongly performed operation for piles

When choosing the homeopathic remedy for fissure, the causative factors are always evaluated, and homeopathic medicine encompassing this cause is chosen. Remedy chosen in such way not only heals the fissure, but also does not allow the problem to recur.

Diagnosis of Fissure

The diagnosis of fissure-in-ano is easy to make clinically and usually no complicated procedures are required to diagnose this condition. Examination by a proctoscope is better avoided. Physician will usually try to avoid putting any instrument in the anus, as the area is extremely sensitive and such examination can be very painful. In majority of cases, with careful evaluation of the symptoms and a close look at the anus, a diagnosis of fissure can be confirmed by a trained doctor.

On examination, the doctor may observe following:

• Spasm of the anus
• A split or cut in the posterior midline of the anal mucosa.
• Lateral fissures: If fissure is observed laterally, instead of posterior midline location of fissure, it may give hint to underlying diseases such as Crohn’s disease, ulcerative colitis, or sexually transmitted diseases. In such cases fissures are usually multiple and may have atypical appearance.
• Acute fissures (usually present for 6 weeks or less) are superficial with sharply demarcated edges.
• Chronic fissures  (present for more than 6 weeks) are usually deeper and may have secondary features, including hardening of the edge of the fissure, a sentinal pile which looks like small skin tag, and hypertrophied anal papillae, etc.

Fissure in Ano Symptoms

• Pain while passing stools: The lower anal canal is exquisitely sensitive area of skin and can produce fairly significant signals of pain if damaged. Sharp agonizing knife-like pain starts when the individual passes stool. The pain is severe and persists for an hour or so. It ceases suddenly. The sufferer is comfortable until the next action of bowel. The individual tends to be constipated rather than go through painful ordeal. If a fissure becomes chronic (long-standing) and deep, another kind of pain can develop. It is a dull ache in the anus and pelvis that starts a few minutes after the bowel movement and can persist for hours after passing stools. This chronic fissure pain is due to spasm of the internal sphincter muscle (one of the small muscles in the anus) and can be quite debilitating.
• Severe spasm of the anal sphincter (as a protective reflex)
• Blood streaked stool (typically on the side of the hard stool) : It is important to note that the bleeding associated with a fissure-in-ano is bright red and associated with some pain or tenderness in the anus. Dark bleeding of greater amount without any anal tenderness or pain should never be ignored and should be brought to the notice of doctor.
• Discharge, swelling, and itching occur especially with chronic fissures. Interestingly, homeopathy has many medicines to relieve the discomfort. Rightly chosen homeopathic medicine covers various aspects of fissure.