What is fissure in ano?

PILES / HEMORRHOIDS ++++ + + Piles
ANAL FISSURE ++ ++++ + Fissure
ANAL FISTULA + ++ ++++ Fistula

fissure-in-anoAnal fissure or Fissure-in-ano is a kind of longitudinal cut (linear ulcer) at the anal canal  outer anterior and posterior margins (skin-lined part) which is formed when a person suffering from constipation passes hard stool with strain. It is extremely painful ano-rectal condition which lead sufferer into stress and anxiety. The person is so much distressed that he/she develops fear for passing stool. This tendency however adds to his problem as it further aggravates the problem of constipation.

Anal fissure commonly occur at midline posteriorly but sometimes seen at midline anteriorly and rarely seen at anywhere in the anal circumference.

The ulcer of anal fissure doesn’t heal up easily because;

  1. The anal canal always full of microorganisms i.e. it is always lodged with infection.
  2. The passage of hard stool during the act of defaecation prevents it from healing easily.

In acute stage the fissure is extremely painful and may bleed frequently but if ignored for a long time for more than 7-8 months, it gets partially healed up and a skin growth known as sentinel tag or sentinel pile surrounds it. This sentinel tag further hinder the complete healing of the underlying fissure.


Who suffer more from Anal fissure the causative factors?

  • People who have a habit of eating junk food and fast food with less dietery fibres.
  • People who drink less fluids and water.
  • People who do not exercise or walk and have sedentary lifestyle.
  • Women during pregnency generally develop constipation and thus anal fissure is seen more in women than men.

How fissure can be prevented?

The primary cause of anal fissures is constipation. So, one has to develop habits by which constipation can be prevented. A few measures can be;

  1. Taking adequate dietary fibers. Eat more vegetables, fruits and salad.
  2. Drink plenty of water and fluids but avoid much coffee and tea.
  3. Avoid straining during defaecation.
  4. Avoid excessive chillies and spices in food items.
  5. Avoid much of non-veg. food. Try to be vegetarian.
  6. Use of buttermilk (Lassi without butter) with a pinch of cumin powder and black salt keeps the digestion correct.

What is the treatment?

fissureIn acute condition, medicines to relieve constipation along with Ayurvedic healing oils for local application, are prescribed. Dilation using anal dilators of appropriate diameters or using index finger is done along with ayurvedic healing oils. However if the condition becomes chronic and sentinel tag has been formed, surgical intervention is necessary.

In Ayurveda the sentinal tag is cut by using a specialized medicated alkaline thread ligation technique, known as Kshara-sutra ligation which offers a better way to treat chronic fissure-in-ano than conventional surgery. Kshara sutra method is least invasive para surgical procedure for cutting benign tissues like sentinel tag, piles masses, warts, condyloma etc. In this technique a highly specialized medicated thread is ligated tightly around the sentinel tag, which strangulate the tissue and cause necrosis thus the tag fall off in 3 to 5 days. The underlying fissure heals up in next 5-15 days. Ayurvedic medicines for constipation and Ayurvedic healing promotion oils like Jatyadi oil or panchguna oil etc.along with Finger dilation of anal canal (Ganesh Kriya) are used till the fissure gets healed completely.

fissure1Sitz bath :- In acute as well as chronic cases of fissure in ano, Sitz bath with lukewarm triphala or panchwalkal kwath is quite helpful in relieving the pain. Patient should use a plastic tub of appropriate diameter and fill it with lukewarm panchwalkal/triphala kwath or simply tap water with some some antiseptic solution and should sit in such a way that his anus and buttocks get submerged inside the warm medicated water. It greatly help in reliving the pain in ano-rectal diseases and gives a soothing effect.Sitz bath is advised in all patients suffering from fissures, piles or fistula in ano and also it is an important part of post operative treatment in ano-rectal cases.

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