Anuradha Varanasi
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Anal fissure is an extremely painful condition where a small cut or tear in the anal lining occurs after straining while trying to pass hard stools. The symptoms include intense pain and burning sensation during and after passing stools, other than rectal bleeding. Anal fissures are very commonly confused with piles or hemorrhoids since both cause rectal bleeding. However, they are two different problems that commonly afflict people. Piles or hemorrhoids are swollen blood vessels in the anus or rectum and the hemorrhoidal veins can get swollen and cause either external or internal piles due to which it can cause irritation and bleeding while passing stools. Here's why you shouldn't ignore rectal bleeding.
The main cause of anal fissures is constipation. However, there is no definite cause of this ailment as I have treated many patients who say they aren t suffering from constipation. What causes the fissures or tear in the anal lining is mainly hard fecal mass or stools. Even if you re not constipated but the beginning of your stool is hard, it will cause fissures, says Dr Rakesh Patel, Gastroenterologist, Fortis Hospital, Kalyan. These are the 6 complications of constipation.
This disease is steadily increasing among Indians, and it is mainly because of all these ready-to-eat foods available in the market along with food that has high levels of trans-fat. Also, lack of exercising, lower fiber intake and other lifestyle changes is resulting in more and more people suffering from anal fissures, adds Dr Patel.
He further adds that chronic fissures have become so common also due to the change in our pooping habits. While earlier we would squat down on Indian toilets, it is now replaced by commodes. Sitting on a pot makes it more difficult to complete our bowel movements because there isn t any adequate pressure, says Dr Patel.
When do you need treatment for anal fissures?
People from varying age groups could suffer from an anal fissure. Normally, anal fissures tend to resolve on its own within two to three weeks once you make changes to your diet and add more fiber. Along with that, your gastroenterologist will prescribe topical gels or ointments for relieving the pain along with stool softeners and laxatives. When treated medically, you will also be told to use a sitz bath. This means sitting in a tub of warm water mixed with potassium permanganate tablets or a povidone iodine solution, covering only your hips and buttocks, at least twice a day. This process aids in keeping your anal area clean and also helps in relieving pain temporarily.
However, if despite undergoing treatment medically, the symptoms still don t subside, you will need to opt for surgery. Only 20% of patients with an anal fissure need surgery and then they are referred to a general surgeon. Otherwise, it is treated medically, says Dr Patel.
These are the surgery options commonly used to treat anal fissures:
Anal dilatation: This surgery prevents the anal opening from becoming smaller and this surgery is performed using general anesthesia. In this procedure, the anus is slowly stretched using anal dilators. You might be told to undergo this surgery following a rectal examination if you re suffering from chronic fissures with recurrent symptoms.
Anal sphincterotomy: In this surgical procedure, an incision is made in the anal sphincter to relax the fissure or tear. This relaxes the tension and pressure on the anal tear and allows it to heal slowly post surgery. In this procedure, the whole physiology is rectified, adds Dr Patel.
STARR procedure: In cases where the patient is diagnosed with obstructed defecation syndrome which is causing the anal tear, your surgeon might suggest a technique called stapled transanal rectal resection (STARR). In this procedure, a surgical stapler is used to remove the excess tissue in the rectum. However, before opting for this, remember that there are certain complications following an STARR procedure such as bleeding, incontinence, fistula, among others. Discuss all the pros and cons with your doctor and take a second opinion if you re considering surgery to treat chronic fissures.
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