Fissure is supposed to be common in constipated people (ones who pass bulky, hard and dry stool) with the habit of suppressing the stool urge. Fissure can occur at any age when you get constipated i.e. even children / infants can have fissure. Babies cry while they defecate due to the pain in case of fissure. But mostly it gets resolved on its own if diet is taken care of. Anal fissure can also be found to coexist with piles, since the scarred or thrombosed area of the pile is supposed to get cracks or fissures. Fissure is mostly present in midline, either in the front or back. Males suffer from fissures mostly in the back end of the anus, whereas females suffer in the front part which are the weak points for men and women.
- Physical strain -Pressure exerted while passing stool
- Defecation – Anal fissure is most commonly caused by constipation. The hard, dry stool tears the anus when it stretches the anus forcibly while defecating. It can also be caused by diarrhoea due to sudden purge or straining after enema.
- Foods – Low fibre diet, more spices, alcohol and lesser intake of water can produce hard dry stool, which needs more strain in defecation
- Weakened anus sphincter muscles – due to any diseases or trauma etc
- Dry skin disorders which affect lower part of anus
- Small tight anus – congenitally small or spastic tight anus
- Cruel pain is the major symptom of fissure – Pain may be burning, stabbing, pricking and a feeling of glass pieces or thorns in the anus. Pain is usually aggravated after defecation. The patients used to suffer with pain for more than half-an-hour after passing stool or for the remaining whole day.
- Bleeding usually occurs at the time of defecation which appears as a streak in the stool. Usually it will be fresh and is supposed to come in drops after defecation but never passes mixed with the faeces.
- Tightness or spasms of the anus usually interrupt in passing the stool
- The fissure is always visible / felt as a swollen triangular (thickened) area with the skin tag in its lower end
- With the fear of pain, patients usually avoid the act of defecation and develop constipation from there which further worsens the condition
- Take plenty of water and fruit juices
- Avoid non-veg and fatty diet
- Take easily digestible, simple food with plenty of vegetables
- Use Indian style toilets since squatting position will be a better position for pain and natural defecation.
- Follow hygienic measures in cleaning and caring
- Pass stool twice a day to avoid dry hard stool and strain to rectum and anus
- Never suppress an urge. Go for stool whenever there is a call since it will be easy then
- Don’t strain to evacuate hard faecal matter. Take time in the toilet for a natural descend with relaxed anus. It is better to have semi-solid stool for easy defecation
- Sitz bath – Before passing stool, sit in a shallow bath tub of warm salt water for 10 – 15 minutes to relax the anal sphincter and to relieve the anal spasm. This technique usually pacifies all the painful anal conditions
- Sporting activities, long-distance walking / travelling / cycling during healing process
- Any friction or injury
- Dry cleaning by toilet papers. Go for wash with warm water which usually soothes
- Scratching, since it may become red, sore and infected.
- Non-veg, fast foods, oily foods, etc.
- Spices and chillies
- Smoking, drinking alcohol and coffee
- Vitamin E and zinc supplementation for better healing.
- Take plenty of water for easy defecation and to avoid constipation.
- Follow regular bowel habits
- Take hygeinic measure to keep anus clean and dry
- Treat constipation or diarrhoea immediately
Superficial fissures usually heal well with simple management and conservative treatment within two weeks. But most fissures are left untreated and so get complicated. The excruciatingly painful fissures often compels the sufferer to opt for treatment. Allopathy usually provides ointments for healing and pain relief. External applications like germicidal or bactericidal or antiseptic or anaesthetic agents or moisturisers or steroid ointments are the common referral list from the doctor’s desk. Internal medicines are mostly avoided, but in case of extreme painful deep fissures, antibiotics are used to control the infection with pain killers. Some will go for anal dilatation, some others will make the stool loosen. But unless anal fissures are cared for properly with diet and habit, no one can get rid of it permanently.
Mostly anal fissure heals without surgery, if it is cared for in its initial days itself. But if it becomes chronic and persistent, then, as a last resort, surgery can be opted. Surgical procedures usually make a linear cut in the spastic anal sphincter muscles to give more way for the faeces, so that faeces can be passed out in a relaxed manner without giving any stretch to the fissure. Then fissure is treated with antibiotic and ointments for easy healing. But, even after surgery, one should be aware of recurrences and should be very careful, particularly in avoiding constipation and strain or otherwise fissure will be back. The complications of surgery may include loss of control in passing flatus (air) and stool urge. Sometimes there may be slight leakage / oozing of faecal matter due to relaxed anus after operation.
Fissure should be treated as early as possible or otherwise it would become chronic fissure which will resist cure. Like in any cut wound, in fissure also, delay in healing makes the fissure lips thicken, which resist the curing process also with its tendency of recurrence. The main reasons for recurrences are
- Though a fissure is well healed after medication or by its own, it will be a weak point which cannot be stretched as before. So, any strain at defecation can cause fissure again.
- The wound usually heals with scar which lacks elasticity of the skin, so any stretch may lead to tear again.
- Rest cannot be offered to anus since it has to expand and contract during every act of defecation and has friction from faeces.
- After having fissure, the anus usually remains contracted than before, for two reasons
1. Natural aiding for close approximation to have better healing
2. Stretch will cause pain, so it remains in a contracted stage to avoid pain.
(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)