Do You Feel Pain When Passing Stool? (ANAL FISSURE)


ANAL FISSURE


What is Anal fissure
Anal fissure is the most common cause for painful defecation (Opening bowels). Most times it is also associated with bleeding but not all the time. It is a small cut in the anal canal up to skin.
Pain while passing motion which can last up to few hours afterwards is the commonest complaint. This is usually associated with Constipation (Passing hard stool/pushing hard to open bowel). At times it is seen after episode of loose motion.

How is such severe pain caused?
Easiest way to understand is, if you sustain a small cut while cutting vegetables, pain will persist till the cut healed and get aggravated when ever anything touches is -- including clothes. Similarly pain get stimulated when the stool passes through the anal canal touching the fissure.

What is the treatment of anal fissure?
When treated appropriately in the initial stages, fissure heals upto 75% with medicines. Longer the duration less likely it is to heal with creams and might need simple surgery to relax the sphincters so that fissure can heal.
Main stay of treatment includes keeping stools soft. This is usually achieved by laxatives during the period of anal fissure but in the long run by eating more fruits and vegetables, drinking at-least 3 lts of water in a day and exercise.
Local anesthetic cream applied 20 mins before passing the motion will help in relieving the pain. Second cream helps to relax the muscle which helps in the healing of the fissure. With this treatment usually 50-60% of fissures heal. 
Next step should be injection of BOTOX into sphincters if patients are affordable. This will increase the chances of healing upto 75-80%. This is more so recommended in females as they have weak and small sphincters compared to men and more over they can also be damaged at the time of vaginal delivery. BOTOX injection causes only temporary relaxation of muscles (upto 6 months) so that fissure can heal.
Other wise in patients in whom fissure does not heal by conservative management simple surgery is required. This will reduce the pain significantly within 24 hrs.

What is Chronic anal fissure?
Any anal fissure which has not healed even after 6 weeks is called chronic anal fissure. Conservative measures are unlikely to work and one might need surgery most of the times.

What are complications of Anal fissure?
A small skin tag (Sentinel skin tag) can develop in chronic fissures. Otherwise some patients can experience itching.
Fissure will never lead to cancer
By
Dr. Maruthesh Gowda
MBBS , FRCS - Laproscopic Surgery , M.R.C.S-General Surgery


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