Fissure Treatment – Cause, Risk factors, Surgery Options, Recovery
An anal fissure (also called fissure-in-ano) is a tear in the skin surrounding the anus (passage that passes out the stool). Anal fissures are uncomfortable and painful and get worse during or after defecation. At times, the anal fissure may bleed a bit. These fissures may occur in adults or in children. Anal fissures most often heal by themselves within a few weeks. They generally occur around the posterior region and only 10%-15% in the front or the anterior region. There may be some cases where the fissures occur in both the places. Fissures located anywhere else suggest other complications.
An anal fissure may occur due to many reasons:
• Irregular bowel habits and straining at stools (Most commonly because of lack of fibre in diet)
• Frequent diarrhoea (underlying problems with the digestive system)
• Severe constipation
• Straining during childbirth
• Over tight anal sphincter muscles
• Injury to the anal canal (Trauma due to accidents or hard, dry bowel movement)
The rare causes for anal fissure include:
• HIV (Unprotected sexual contact or sharing a syringe or even infected blood transfusion)
• Anal cancer
• Herpes infection
• Anal intercourse
• Recent childbirth
Apollo Spectra is well renowned name when it comes to treatment of Anal fissures. Anal fissures cause difficulty and pain during defecation and hence compels the patient to hold on to it and thus causing constipation. Constipation further results in heavy and large stool which aggravates the situation for the patient. This can also affect the patient’s urination (dysuria), where the patient feels pain and discomfort while urinating. At Apollo Spectra, the treatment is focused upon breaking the rotation of spasms of the sphincter muscles in the anus and hence the constant breaking or tearing of the anoderm. We have successfully treated many patients with anal fissures and provide specialised services to meet patient needs.
In the case of acute fissures, surgical methods are rarely needed and there are medicines available which can be used to heal the fissure. These medications reportedly have a healing rate of around 85% for the acute fissures but only 40% for the chronic fissures.
The initial treatments that we offer, are concerned with adding bulk to the stool while softening it with methylcellulose or psyllium in diet. These are available as over- the- counter preparation mixes.
- Contemporary anaesthetics, like lidocaine, is used for the pain in the anal canal.
- Frequent Luke-warm baths can give a soothing sensation, in order to relax the anal canal muscles. They are called Sitz baths and help with the spasms and the flow of the blood to the anal regions. They also clean the anus which saves rubbing and scratching the already irritated anoderm.
- Refraining from foods which may pass out undigested (nuts, popcorn, etc)
- Increasing the amount of liquid intake.
• Nitro-glycerine Ointment
Petroleum compounded with nitro-glycerine is commonly used to treat acute as well as chronic fissures. The internal sphincter muscles are chemically relaxed by the nitro-glycerine. Due to the relaxation of the sphincter muscles, slowly the flow of blood to the site of injury increases, subsequently increasing the rate of healing. However, in the case of chronic fissures, nitro- glycerine can be used in only 50% of the cases where non-operative measures are opted. This can be assisted by increasing the intake of water and fibre. Nitro-glycerine has some side effects which majorly include occasional headaches, which are observed in about 30% of the patients.
• Calcium Channel Blockers
Medications such as these include Nifedipine and Diltiazem. It is a more general way of treating fissures. The side effects include drop in blood pressure and minor headaches. There are certain forms of Calcium Channel blockers that are ingested, but the healing capability is reduced and the side effects are increased.
• Steroids and Anaesthetics
Anaesthetics like lidocaine, pramoxine, xylocaine, tetracaine reduce the pain during a bowel movement and are hence recommended right before defecation.
• An injection of Botulinum toxin into the sphincter muscles of the anus and the surgical separation of a section from the internal anal sphincter. The purpose of these treatments is to help with the easing of the anal sphincter muscle. This would result in a decrease in the number of spasms and anal pain, which in turn would allow the healing of the fissure. The sentinel pile can be removed to stimulate the healing process of the fissure. The risks of these procedures are that it can interfere with the person’s capability to control stool and gas.
Botulinum Toxin injections result in complete recovery in most of the patients (around 50% to 80%). These injections are given as a procedure carried out in the same day and can occasionally be performed in a clinic or an office setting.
• Lateral Internal Sphincterotomy usually has a success rate of 90% and above and is often recommended to patients. Chances of recurrence of the fissures are exceedingly low if it is performed by an experienced surgeon. The main risk of this type of surgery is gas incontinence and irregularity in the degree of stool.
The patient would be fit enough to resume normal work and daily activities in just a few days after the surgery. We understand that patients may feel anxious after getting discharged and that’s why Apollo Spectra is here to provide skilled care to your loved ones.
At Apollo Spectra, patient safety is a top priority. Our team make sure strong lines of communication between doctors, families and staff.
As soon as the pain starts or you see a bloody bowel movement.
• Is the surgery safe?
Yes, it is perfectly safe. Book your appointment today at Apollo Spectra.