1. Introduction

An anal fissure is a small tear or cut in the lining of the anus, which can cause pain and bleeding during or after bowel movements. Though commonly associated with constipation, anal fissures can also occur due to other factors. Both men and women of any age can develop this condition, though it is particularly prevalent in infants and young children.

Causes
The primary cause of anal fissures is trauma to the anal canal. This trauma can result from:
– Passing large or hard stools
– Chronic constipation or diarrhea
– Straining during childbirth
– Anal intercourse
– Inflammatory conditions like Crohn’s disease

 

 

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Locations
Anal fissures typically occur in the posterior midline of the anal canal. However, they may also appear in the anterior midline. Fissures located laterally (on the sides of the anus) may be indicative of underlying conditions such as Crohn’s disease or other pathologies.

For location, watch following video:

https://youtu.be/Qmwad5nT1BA?si=_W4B-DGfKG2ILqHq

Male and Female Ratio
Anal fissures affect both men and women equally. However, certain causes related to childbirth may make women more susceptible at certain times in their lives.

Signs and Symptoms
The primary signs and symptoms of anal fissures include:
– Sharp pain during or after bowel movements
– Bright red blood on the stool or toilet paper
– Itching or irritation around the anus
– A visible crack or tear near the anus
– A small lump or skin tag near the tear

 

Diagnosis
Diagnosing an anal fissure typically involves a physical examination of the anal area. A healthcare provider may use an anoscope to take a closer look if necessary. In cases of chronic or recurrent fissures, additional tests like colonoscopy may be recommended to rule out other conditions.

Management Options
1. Home Remedies
– Sitz baths: Soaking the anal area in warm water for 10-20 minutes several times a day can help soothe irritation and promote healing.

How to do sitz bath watch following video:

https://youtu.be/4RuU8l94B74?si=C9cduhxIPKQ57TOz
– Fiber-rich diet: Consuming foods high in fiber, such as fruits, vegetables, and whole grains, helps soften stool and reduce straining.

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– Hydration: Drinking plenty of water aids in preventing constipation.

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– Avoid straining: Ensuring a gentle bowel movement reduces trauma to the anal area.

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– Topical applications: Coconut oil and aloe vera can be applied to soothe the area and support healing.

2. Medical Treatments
– Topical anesthetics: Over-the-counter creams or ointments containing lidocaine can relieve pain.
– Nitroglycerin ointment or GTN 0.2% cream: Used to increase blood flow to the area and promote healing.

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https://youtu.be/sd5GSmSEfI4
– Calcium channel blockers (e.g., nifedipine, diltiazem): Applied topically to relax the anal sphincter muscle.
– Botox injections: Used in chronic cases to temporarily paralyze the muscle and reduce spasms.

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When Surgery is Necessary
Surgery is usually considered when conservative treatments fail, and the fissure becomes chronic (lasting more than 6-8 weeks). Surgical options may also be necessary for recurrent fissures that severely impact a patient’s quality of life.

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Surgical Options
1. Lateral Internal Sphincterotomy (LIS)
This is the most common surgical procedure for chronic anal fissures. It involves making a small incision in the internal anal sphincter muscle to reduce spasm and promote healing. LIS has a high success rate, but there is a small risk of minor incontinence.

How LIS is done, watch following video:

https://youtu.be/vRMX19hEBxQ

2. Fissurectomy
Less commonly performed, this procedure involves removing the fissure and surrounding tissue to allow for new tissue growth.

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Aftercare Post-Surgery
After surgical intervention, proper care is essential for recovery:
– Pain management: Use prescribed painkillers and continue warm sitz baths to ease discomfort.
– Maintain a high-fiber diet: This helps ensure smooth bowel movements and reduces the risk of recurrence.
– Avoid straining: Follow-up with stool softeners if needed.
– Hygiene: Gently clean the anal area and keep it dry to prevent infection.
– Follow-up visits: Regular check-ups with a healthcare provider are important to monitor healing.

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 Conclusion
Anal fissures can be painful but are often treatable with simple home care and medical management. If chronic, surgery may be required to achieve lasting relief. Proper aftercare following surgery is vital to prevent recurrence and promote healing. Consult with a healthcare provider for the best course of treatment tailored to your condition.

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