FAQ - Fissure

Fissure  

Fissure and piles are two different ailments though people think they are the same. Three different types of ailments exist : a wound inside the anus (fissure-in-ano) abscess near anus (perianal abscess) and anal fistula (fistula in ano). Lack of exercise, irregular food habits, lack of fibre content in food and tension cause constipation. This results in hard stools and poor bowel movement. And one has to apply excess bowel force to defecate. This causes a tear in the delicate inner lining of the anus and a wound develops. The wound stiffens the anal muscles (sphincter) and the anus remains closed tightly. Hard stool causes more abrasion of the wound. If not treated, the wound will not heal. The bacteria present in the stools infect the wound leading to an abscess near the anal opening. The abscess has to automatically burst open and pus drained or has to be incised and drained surgically by a doctor. If it is not done, the abscess bursts outside the anal opening and it causes what is called as anal fistula.

Anal fissure or fissure in ano What is anal fissure ?

It is a wound present inside the anus where the inner skin of the rectum joins the outer skin of the anus.

Why does it occur ?

Frequent constipation, the resulting hardening of stools and the need to exert excess bowel pressure are the main causes. It may occur in any person but occurs mere frequently in the age-group of 20-40 years.

Why does it not heal on its own ?

Hard stool causes abrasion of the anal skin and the wound fails to heal moreover, stools contain bacteria and cleanliness is not possible.

What are the symptoms ?

Acute pain near anus while passing stools and sometimes the patient passes blood along with stools. Mild pain persists for some time after defecation.

How is it diagnosed ?

If the wound is recent, the opening of anus remains tightly closed. Even the doctor finds it difficult to insert a finger for an internal examination. If the wound is old and when the finger is inserted inside the anus, the wound feels to be like a “button hole”.

What is the treatment ?

For a fresh wound, medication is useful. A mild lubricating laxative will help. Vegetables and fruits with good fibre content help to soften stools and have proper defecation resulting in the healing of the wound. The patient should take a “sit-in-bath”. It means one should sit in a tub filled with warm or tolerably hot water after defecation. This helps the anal muscles to relax; the wound also gets cleaned. An anaesthetic ointment can be used to get relief from the burning sensation. These types of treatment help in the healing of wound in about 60% of the cases. However, proper fibre content in the food should be maintained and care to avoid constipation must be taken to future occurrence of fissure.

Why is the surgery needed ?

Old wounds need an operation. Such wounds do not heal with medication and treatment. It is a small surgery carried out under general anaesthesia given only for a short duration. The stiff muscles surrounding the anus are given a small cut or are stretched to relax them. The thickened edges of the wound are cut and removed. Only one day’s hospitalization is needed.

Does the operation cause any trouble ?

For about a week, the anal opening may be a little loose; there may be some amount of bleeding also. However, control over defecation remains intact. After 2-3 weeks, the wound completely heals and there is no further trouble.

Does the wound recur after operation ?

The original wound due to fissure gets completely cured. However, if the patient continues to constipate, another wound can occur.

Abscess near anus (Perianal abscess) What is perianal abscess ?

It is an abscess that develops close to the anus in the soft fatty muscular part under the skin.

Why does it occur ?

Usually, it occurs due to the infection of a wound in the anus. The roots of the hair surrounding the anus get infected and an abscess develops.

What are the symptoms ?

A painful knot develops in the-softer part near the anus. The pain increases at the time of defecation or while sitting on a hard surface. Sometimes the person also gets fever.

How is it diagnosed ?

Examination of the anus with a finger is sufficient to diagnose it.

What is the treatment ?

Administration of painkillers and antibiotics does help in some patients.

What type of operation is performed? When ?

Once an abscess develops, an operation is needed as early as possible. General anaesthesia is given for a short duration. The abscess is cut open and pus is drained. A cotton wick soaked in medicine is pressed into the cavity of the abscess. The wound has to be dressed daily after defecation.

When does the wound heal ?

Depending upon the size of the abscess and the type of infection, the wound heals between 2-4 weeks. However sometimes, despite all care the wound does not completely heal. This is an indication that a fistula develops.

What is anal fistula ?

It is an unnatural tubular passage that develops and joins the skin surrounding the anus on the one end, and rectum or inside of anus on the other (see figure)

Why does it develop ?

Usually, it occurs due to a neglected and untreated wound in the anus which ultimately forms an abscess near the anus (as described earlier). Other causes are T. B. of the rectum or cancer of the rectum, Other diseases of the large intestine such as ulcerative colitis, Crohn’s disease or wound caused by a sharp object may also result in anal fistula.

What are the symptoms ?

The skin surrounding the anus may develop a single or multiple holes. It exudes thin pus intermittently.

How is it diagnosed ?

The inner hole can be felt on insertion of a finger. It can also be seen with a “scope” which is a special tube like instrument. If the inner hole is in the anus it is called as “lower fistula”, if it is in the rectum it is called “upper fistula”.

What is the treatment ?

Fistula cannot be cured by medication. But infection in the fistula can be reduced with drugs.

How is the operation performed ?

Nearly 90% of the cases suffer from lower fistula and this operation is not very complicated. The patient is given a spinal anaesthesia. The tube like fissure,- is cut open and the affected tissue is removed. The wound is not stitched but kept open and allowed to heal with proper dressing. It takes about 2 to 6 weeks to heal. About 10% cases are of upper fistula and the operation is complicated. An attempt is made to clear the tubular fistula by cutting minimum number of muscles of the anus.

Does fistula occur again ?

Despite complete cure, in about 10 to 20% cases the wound does not heal completely or a wound that has healed may get opened again. In such cases, another operation has to be performed. In Ayurveda, a method of medication called as “Ksharsutra” which is known to cure fistula in some cases. However, it is safe to avoid treatment from quacks.

 

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