Anal Fissure

Anal Fissure is a longitudinal or ulceration in the lining of the anal canal or is a crack like sore in the anal region. The tear usually extends from the anal opening and located posteriorly in the mid-line.

Causes:
Most anal fissures are caused by stretching of the anal mucosa beyond its capability various causes are,

• Trauma of passing a large firm stool.
• Tightening of the anal canal because of stress and anxiety.
• Severe and chronic constipation
• Severe and chronic diarrhea.
• Crohn's disease and ulcerative colitis.
• Tight sphincter muscle.
• Anal Intercourse.
• Child birth.
• Trauma
• Overuse of laxatives.

Clinical Features:

• Pain during and even hours after defecation.
• Burning, possibly painful itching.
• Visible tear in the anus.
• Constipation.
• Bleeding; Blood on the stool or on toilet paper.
• A tearing sensation during daofication.

Management:

1. Medical management
2. Surgical management

Conservative / Medical Management:
For many years up until 1995, customary Rx includes:

• warm baths
• sitz baths
• Topical anesthetics
• Stool bulking agents
• Mechanical anal stretching
• Emollient suppositories
• Increase in water intake.
• A suppository combining an anesthetic with a corticosteroid helps to relieve the discomfort. Anal diation under anesthesia may be required.

Surgical Management:
Lateral internal sphincterotomy with excision of the fissure, the success rate is 90%-95%.
Potential complication after surgery.

• infection
• anal leakage.

Prevention:
In infants under 1 year, frequent diapper change can prevent anal fissure. For adults, the following can prevent fissure:

• Treating constipation by eating food rich in dietary fibres, avoiding caeffin, drinking a lot of water and taking stool softener.
• Treating diarrhea promptly.
• Lubricating the anal canal with water based tube (petroleum jelly is not recommended because it can harbor harmful bacteria).
• Avoiding straining or prolonged sitting on the toilet.
• Using a moist, wipe instead of perfumed and harsh toilet paper.
• Keeping the anus dry and hygiene.
• When using anal parm (cream) don't use the dispenser which can injure the area. Instead use a finger to insert a pea size amount of cream.
• Carmex lip ointment also helps and is much expensive then analpam.