Anal Fissure

Definition:- An Anal fissure or Rectal Fissure is a break or tear in the skin of the anal canal
Description:- Anal fissures may be noticed by bright red anal bleeding on toilet paper, sometimes in the toilet. If acute they may cause pain after defecation but with chronic fissures pain intensity is often less. Anal fissures usually extend from the anal opening and are usually located posteriorly in the relatively unsupported nature and poor perfusion of the anal wall in that location. Fissure depth may be superficial or sometimes down to the underlying sphinter muscle.
Causes :-
 Most anal fissures are caused by STRETCHING of the mucosa beyond its capability
 The most common cause of non healing is spamming of the internal anal sphincter of the internal anal sphincter muscle which results in impaired blood supply to the anal mucosa.
 Other common causes of anal fissures include; Childbirth trauma in women Crohn’s Disease Ulcerative Colitis
Epidemiology:- The incidence of anal fissure is around 1 in 350 adults. They occur equally commonly in men and women and most often occur in adults aged 15 to 40
Prevention:- For Adults;
 Avoiding straining when defecation,
 Careful anal hygiene after defection,
 In case of pre-existing or suspected fissure, use of a lubricating ointment,
 In infants, frequent diaper change can prevent anal fissure
Treatment:- Non- surgical treatment are recommended initially for acute and choric anal fissures. These include topical Nitroglycerin or calcium channel blockers or injection of Butulinum toxin into the anal sphincter
Other measures include warm Sitz baths, topical anesthetics, high fiber diet and stool softerners
Medication:-
 Local application of medication to relax the sphincter muscle, thus allowing the healing to proceed, with Nitroglycerine ointment
 Calcium channel blocker with Nifedipine ointment
 A combined surgical and pharmacological treatment, administered by colorectal surgeons, is direct injection of Botulinum toxin(Botox) into the anal sphincter to relax it.
Surgery:-
1) Lateral internal sphincterotomy
2) Anal dilation
3) Stretching