FISSURE IN ANO

FISSURE IN ANO

Definition: A fissure in ano is a small tear or cut in the lining of the anus, often accompanied by bleeding, itching, or discomfort.

Types:

• Anal fissure: A small tear in the lining of the anus.
• Anal fistula: An abnormal connection between the anus and the skin around it.
• Anal fistula-in-ano: A combination of an anal fissure and an anal fistula.

Etiopathogenesis:

• Causes: • Passing large or hard stools. • Straining during bowel movements. • Constipation. • Diarrhea.
  • Anal sex.
  • Pregnancy.
  • Previous anal surgery.
• Pathology: The anal sphincter muscle is stretched and torn, leading to bleeding, pain, and discomfort.

Clinical Features:

• Symptoms: • Pain during and after bowel movements. • Bleeding from the anus. • Itching or burning sensation in the anus. • Difficulty passing stools. • Mucus discharge from the anus.
• Physical Examination: • A visible tear or cut in the anus. • Swelling and redness around the anus. • Pain when the anal sphincter is stretched.

Investigations:

• Digital examination: To confirm the presence of a fissure.
• Anoscopy: To visualize the anal canal and surrounding tissue.
• MRI or CT scan: To rule out other conditions, such as an anal fistula or abscess.

Complications:

• Chronic pain: Ongoing pain and discomfort.
• Bleeding: Recurrent bleeding from the anus.
• Infection: Bacterial infection of the anal fissure.
• Anal fistula: Development of an abnormal connection between the anus and the skin.

Non-surgical Management:

• Topical treatments: Nitroglycerin ointment, calcium channel blockers, and glyceryl trinitrate to relax the anal sphincter.
• Hydrotherapy: Warm baths or sitz baths to reduce pain and discomfort.
• Dietary changes: Increasing fiber intake, drinking plenty of water, and avoiding spicy or acidic foods.
• Pelvic floor exercises: Kegel exercises to strengthen the anal sphincter.

Surgical Management:

• Lateral internal sphincterotomy: A surgical procedure to cut the anal sphincter muscle and relieve tension.
• Anal fissure repair: A surgical procedure to repair the torn anal lining.
• Anoplasty: A surgical procedure to remove excess skin and tissue around the anus.

Homoeopathic Therapeutic Medicines:

• Arsenicum album: For chronic pain and bleeding.
• Calcarea carbonica: For constipation and anal fissure.
• Sulphur: For itching and burning sensation.
• Nux vomica: For straining during bowel movements.

Surgical Procedure: 1 → Preparation: The patient is positioned in the lithotomy position, and the anal area is cleaned and draped. 2 → Anoscopy: The anal canal and surrounding tissue are visualized using an anoscope. 3 → Sphincterotomy: The anal sphincter muscle is cut using a scalpel or laser. 4 → Repair: The torn anal lining is repaired using sutures or staples. 5 → Closure: The surgical site is closed with sutures or staples.