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Fissure in Ano

It is severe painful condition while passing toilet or stools due to tear or crack in anal canal.
People are mistaken with Piles or Hemmorhoids.
They are of 2 types

  • Acute Fissure in Ano
  • Chronic Fissure in Ano

Causes

  • Hard stools & straining during toilet
  • Constipation
  • Diarrhea
  • Obesity
  • Pregnancy & after Delivery
  • Low Fiber Diet

It can also be secondary to 

  • Crohn's disease
  • Anal cancer
  • HIV
  • Tuberculosis
  • Anal Sex

Symptoms

  • Severe Burning Tearing pain
  • Fresh red Blood streaked stools
  • Itching
  • Sentinel Skin Tag like Swelling at anus

Diagnosis

Assessment of patient is must

  • Detailed History & Symptoms
  • Digital Rectal Examination with finger
  • Anoscopy if possible
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Fissure Surgery
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Sentinel Skin Tag in Chronic Fissure in Ano
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Fissure Treatment

Treatment

  • Most of Acute fissure in ano heals spontaneously without surgery by home treatment like dietary changes , food tips, High fiber diet.
  • Medicines
  • Laxatives
  • Warm Sitz Bath
  • High Fiber Diet
  • Adequate Water Intake
  • Topical Ointments or Cream

It helps you to pass motion easily without friction & with Less pain.

  1. Whole grain cereals
  2. Oats 
  3. Isapgul husk with milk / water
  4. Boiled vegetables, Salads like broccoli, cabbage, carrots
  5. Leafy Vegetables Like Palak, Methi, green Coriander
  6. Brown Rice
  7. Legumes
  8. Fresh Fruits Like apple, Mosambi, Orange 
  9. Berries
  10. 1 cup of cooked quinoa
  11. Whole wheat Brown bread
  12. DRINK MORE WATER – atleast 8 glasses of water
  1. Chillies & Chili based powders, Garam Masala
  2. Chutney pastes
  3. Garlic 
  4. Maida or refined wheat flour based items like bread, Pav , Biscuits
  5. Red Pepper
  6. Brinjal
  7. Pizza 
  8. Chipotle dressing, jalapeno dressing, chili Sauces
  9. Coffee, Alcohol, cola aerated drinks 
  10. STOP SMOKING

Apart from Dietary recommedations, Some Office based or OPD medical treatment may be needed in severe relentless painful conditions.

  1. Botox or Botulinum Injection ( Chemical Sphincterotomy )
  2. Nitroglycerine Ointment, Diltiazem ( Medical sphincterotomy )
  3. Pain Killers to decrease pain, anal spasm 
  4. Laxatives & Stool Softeners
  5. Use Soft Baby wipes instead of toilet paper & Wipe gently after using toilet

 

These are temporary measures which relieves anal sphincter spasm , decreases pressure resulting in increased blood supply giving an opportunity for healing of fissure.

Long standing like Chronic Fissure or complicated Fissure in Ano after trying diet changes & medical treatment may need surgery or  which fulfils below criteria

  1. If not responding to conservative treatment.

  2. If a fibrous anal polyp is present.

  3. Presence of an external skin tag is noticed.

  4. Presence of hemorrhoid is visible.

  5. Induration is indicated at the edges of fissure.

  6. If there is exposure of the fibers of the internal sphincter at the floor of the fissure.

  7. The base of fissure is infected.

  8. A bridged fissure with underlying fistula [a post fissure fistula] is diagnosed.

Above factors are less likely responders to conservative remedies & hence definitive permanent solution is required.

Surgery / Operation

Best treatment for Chronic fissure – Lateral Internal Sphincterotomy

Very high success rate.

Healing is seen in upto 95 to 98 % of patients.

  1. Lateral Internal Sphincterotomy – Open or Closed
  2. Laser Sphincterolysis or Sphincterotomy – Open or Closed
  3. Anal / Rectal Advancement –  Flaps / Anoplasty – In Low Anal tone
  4. Fissurectomy
  5. Anal Dilatation – No Longer Recommended or Obsolete

Recovery

Hospital Stay
1 to 0 Days
Office Work
1 to 1 Days
Medicines
1 to 3 Days
Healing
7 to 8 Days

Fissure surgery is highly reliable with very high satisfaction & success rates. 

Overall Complication rates are very Low as compared to other surgical treatment modalities. 

They may occur as

 

  1. Immediate

           Abscess 

                       Temporary Incontinence 

           Infection or Abscess

           Fistula Formation

 

2. Delayed or Late

Recurrence ( Less than 1 to 2 % )

Incontinence

Stool Softeners & Laxatives for 2-3 weeks

Follow Diet as instructed by your doctor

Chronic Fissure in Ano

Perianal Abscess

Fistula in Ano

Anal Stenosis

No. It does not lead to cancer.

Can present as anal ulcer which may mimick fissure but in reality might be anal cancer.

So it is always advisable to get it checked by your surgeon.

TESTIMONIALS

Dr. Chintan Patel is one of the best Surgen for the Piles, Fissure, Fitsula and Surgery cost also is very affordable, So I will recommend everyone to pls visit if anyone facing the related problem
RAHUL
Patient

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