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Fissures

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  3. Fissures

Overview of Fissures

Fissures Meaning in Urdu

جب آپ قبض کا شکار ہوتے ہیں بڑی آنت کے آخری سرے پر موجود ٹشوز متاثر ہوتے ہیں۔ ان ٹشوز کے متاثر ہونے کی وجہ سے تکلیف کا سامنا کرنا پڑتا ہے، جب کہ کچھ مرتبہ پاخانہ کرتے وقت خون بھی خارج ہوتا ہے۔ یہ بیماری چھوٹے بچوں میں بہت عام ہوتی ہے، تاہم یہ بڑوں کو بھی متاثر کر سکتی ہے۔ فشرز کی کئی اقسام کو آسانی کے ساتھ کنٹرول کیا جا سکتا ہے۔ فائبر کو زیادہ مقدار میں استعمال کرنے سے اس بیماری کی شدت میں کمی آتی ہے۔ فشرز کی وجہ سے بڑی آنت کے آخری سرے پر موجود ٹشوز کے نزدیک ایک چھوٹی سی گلٹی بھی نمودار ہو سکتی ہے۔

Fissures are small cuts in the mucous membrane of the anal canal. These tears develop due to trauma or injury that stretches the anal canal. An anal fissure is developed when a person passes large or hard stool during bowel movements. These fissures usually cause pain and bleeding with bowel movements. A person with fissures may experience spasms in the anal sphincter muscles. 

Typically, anal fissures develop in young infants but can affect them at any age. It is not a serious condition and usually heals on its own. However, treatment is required to heal pain and discomfort. Usually, these fissures can be treated with simple treatments, such as increased fiber intake. However, in some cases, people may need medication or, occasionally, surgery.

Signs and Symptoms of Fissures

Some of the common symptoms of anal fissures are:

  • A visible tear in the skin around the anus
  • Streaks of blood on stools or on toilet paper after wiping
  • A skin tag, or small lump of skin, next to the tear
  • Sharp pain in the anal area during bowel movements
  • Burning or itching in the anal area

Types of Fissures

Causes of Fissures

Typically, anal fissures develop due to passing large or hard stools. However, chronic constipation or frequent diarrhoea can cause the tearing of skin around the skin. Some other common causes of fissures are:

  • Straining during childbirth or bowel movements
  • Overly tight or spastic anal sphincter muscles
  • Inflammatory bowel disease (IBD), such as Crohn’s disease
  • Decreased blood flow to the anorectal area

Less common symptoms of anal fissures include: 

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Risk Factors of Fissures

Some factors that increase the risk of developing fissures are:

  • Constipation: Anal muscles strain during bowel movements and passing of hard stools. These strains increase the risk of tearing due to constipation. 
  • Childbirth: Mostly, pregnant women develop anal fissures during childbirth. 
  • Crohn's Disease: A condition in which the intestinal tract is inflamed. This condition makes the anal muscles more vulnerable to fissures. 
  • Age: Anal fissures can develop at any age, however mostly infants and middle-aged adults are affected.

Health Complications Related to Fissures

If fissures don’t heal with care and medications, they can lead to complications such as:

  • Failure to Heal: An anal fissure that doesn’t recover within 1-2 months is called a chronic fissure that requires further treatment.
  • Recurrence: Once you've developed an anal fissure, the chances of its recurrences are increased.
  • Damaging of Internal Anal Sphincter: If an anal fissure is not treated properly, the tear can extend to the internal anal sphincter muscles that hold the anus. It results in prolonged discomfort which can only be treated by medications and surgical removal of fissures.

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Prevention

Given below are some of the proper preventive measures for fissures:

In the Case of Infants:

You can prevent the occurrence of fissures in your child with the help of the following tips:

  • Make sure to change the diapers frequently 
  • If constipation is the cause, make sure to treat it
  • Make sure your child is hydrated 

In the Case of Adults:


Following are some of the best preventive measures for fissures in adults:

  • Make sure to keep the anorectal area dry 
  • Clean or wipe the area with soft materials. Refrain from using hard material clothes. 
  • Do not use rough and scented toilet paper 
  • Refrain from eating foods that lead to irritation in the rectum
  • Make sure to treat diarrhea and constipation 
  • Avoid dehydration
  • Exercise regularly 
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Diagnosis

Your doctor will inquire about your medical history before performing a physical exam.

  • Physical Examination: Physical examination is performed by a gentle inspection of the anal region. Usually, anal fissures can be diagnosed just by physical examination because the tear is visible. 

An acute fissure appears like a fresh tear, while chronic fissures look like deeper tears. In chronic fissures, fleshy growths appear both inside and outside of the anus that lasts for about 1-2 months. The cause of the fissures can be determined by their location. A fissure that develops on the surrounding skin of the anus could be a sign of an underlying condition such as Crohn’s disease.

In this condition, the doctor will recommend the following tests: 

  • Anoscopy: Anoscopy is performed to get a detailed image of the rectum and anus. In this procedure, a tubular device called an anoscope is inserted inside the anus.  
  • Flexible Sigmoidoscopy: Flexible sigmoidoscopy is performed to examine the lower part of the intestine. In this procedure, a thin, flexible tube sigmoidoscope is inserted into the colon. This procedure is performed if you are under the age of 50. 
  • Colonoscopy: Colonoscopy is performed to diagnose the entire colon. This is performed if you are above 50 and have risk factors for colon cancer. In this procedure, a thin flexible colonoscope is inserted inside the rectum.  

Treatment of Fissures | When to Consult a Doctor

Fissures can be treated by the following methods:

  1. Self-Care

If your fissures are caused by hard stools or diarrhea, the strain on the anus muscles can be reduced by changing a few habits. By following self-care tips, symptoms of fissures can be relieved. 

  • Stay Hydrated: Drink caffeine-free fluids because excessive alcohol and caffeine can cause dehydration. 
  • Eat Fiber-rich Diet: Constipation can be avoided by adding 20-35 grams of fiber to an everyday diet. Later, you can gradually increase the amount of fibre by using a diet containing: 
  • Wheat bran
  • Peas and beans
  • Oat bran
  • Whole grains, including brown rice, oatmeal, and whole-grain pasta, cereals, and bread
  • Prunes and prune juice
  • Citrus fruits
  • Fiber Supplements: Try to use fiber supplements if you can’t get enough fiber from food. Fibers make the stools more regular and easy to pass. These supplements also help to reduce gas and cramping.
  • Over-the-counter Laxatives: If fiber supplements don’t help, try to use over-the-counter laxatives as per the doctor’s suggestion. 
  • Avoid the use of irritating scented soaps or bubble baths for cleaning.
  • Get Treatment for Chronic Constipation or Ongoing Diarrhea: Fissures can be treated by adding fibers to your diet to keep your stool soft. Healing can be promoted by soaking in warm water for 10 to 20 minutes, especially after bowel movements.

If your symptoms don’t go away, you may need further treatment.

  1. Nonsurgical Treatments

The doctor may recommend you following treatments:

  • Topical Anesthetic Creams: Topical creams such as lidocaine hydrochloride (Xylocaine) can be used as per the doctor’s suggestion to relieve pain.
  • Externally Applied Nitroglycerin (Rectiv): Nitroglycerin is used when other conservatives are not helping. It helps in the healing of fissures by increasing the blood flow to the affected area. Side effects of nitroglycerin may include a severe headache.
  • Botox Injection: Botulinum toxin type A injection paralyzes the sphincter muscles and relaxes contractions.
  • Blood Pressure Medications: Blood pressure medicines relax the anal muscles. These medicines include oral nifedipine (Procardia) or diltiazem (Cardizem). These medications can be taken orally or applied topically. These medicines can be used as an alternative to nitroglycerin.

Surgical Treatment

Surgery is performed if the fissures are chronic and resistant to other therapies. The surgical treatment for the fissures includes:

  • Lateral Internal Sphincterotomy (LIS): In this procedure, a small portion of the sphincter muscles are cut. This procedure helps to reduce contractions and pain and also promotes healing.
  • For chronic fissures, surgery is an effective treatment procedure. But, surgery can cause incontinence.

Consult your doctor if you experience pain during bowel movements or notice blood on stools or toilet paper after a bowel movement.

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