Anal Fissure
It is vertical tear/ulcer in the lower anal canal. Commonly seen in midline posteriorly. It is a superficial but very distressing painful condition. It affects men and women equally and occurs at any age.
Causes :
Hard stool especially associated with constipation:
Diarrhoea
Iatrogenic
Anal sex
Rare causes
Types :
Acute and Chronic:
Acute
Chronic:
Sign & Symptoms :
It is a deep tear in anal canal with severe sphincter spasm. It presents with severe pain and constipation. Acute agonizing burning / pricking / searing pain during defecation and lingering thereafter for a few mins to few hrs. pain is so severe that the patient sometimes suffers from giddiness (syncopal attack). Patient avoids food to avoid the terrible experience of pain after defecation.
Bleeding
- sometimes bleeding occurs with stool, that strakes on a stool. Sometimes 5-10 drops of blood can be seen in flush pan
Painful Straining
- because of severe anal sphincter spasm patient has to stain during defecation.
Pruritus ani
- Itching In Anal Region.
Sentinel Pile
- In chronic cases margins of ulcer are indurated .at the lower end of ulcer there is skin tag like growth which acts like a guard -sentinel pile. It can cause repeated infection -abscess formation-fistula formation.
Diagnosis :
A history of your symptoms along with Per rectal examination with naked eye shows a vertical tear in anal canal is confirmatory of diagnosis.
Sometimes your doctor may advise you some tests to rule out any suspected underlying cause for fissure.
Treatment :
Conservative treatment: when fissure is acute, small and with minimal pain. a topical anesthetic ointment such as lignocaine jelly. Laxative such as Isabgol or liq. paraffin can be used to reduce pain.
Surgical treatment :
Lord’s anal dilatation
- In this spam of sphincter of anal canal is released by starching of sphincter by fingers after giving general or spinal anaesthesia.
Laser Surgery
- In this procedure anal sphincter is cut opened through small incision.
Lateral Sphincterotomy (wide dialatation of sphinter)
- In this procedure anal sphincter is cut opened through small incision.
Fissurectomy
- Excision of fissure and division of fibres of internal sphincter running transversely in the base of fissure.
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Location
- Ramkrishna hospital, Laxmi Chambers, 1536, Tilak Rd, Ramashram Society, Perugate, Sadashiv Peth, Pune- 411030
- Citi care hospital, Shubham gallery, next to chroma, near pimpri bridge, Pimpri- 411018