Bowel movement is one of the most important activities in order to remove the unnecessary products from the body. However, in some cases bowel movement happens with more difficulty and people have to struggle with it. A lot of attempts turn out to be disastrous when the anus is torn and then it is called as Fissure in Ano . This affects the daily life seriously.

Bowel movement is one of the most important activities in order to remove the unnecessary products from the body. However, in some cases bowel movement happens with more difficulty and people have to struggle with it. A lot of attempts turn out to be disastrous when the anus is torn and then it is called as Fissure in Ano . This affects the daily life seriously.

It is a longitudinal ulcer in the anal canal, posteriorly situated in majority of cases. The squamous mucosa of lower half of anal canal is prone to superficial ulceration which presents as an anal fissure.

Types:

1.            Acute Fissure: This is a deep tear in the anal canal with surrounding oedema and inflammatory in duration. It is also associated with spasm of anal sphincters. Bright streak of blood with passage of stool and pain after daefecation is characteristic features.

2.            Chronic fissure: When acute fissure fails to heal, it gradually develops into a deep undermined ulcer with continuing infection and oedema. It is also associated with hypertrophic papilla or skin tag known as sentinel pile. It is also very painful.

Factors Responsible for Fissure in Ano

1.            Passage of hard stool.

2.            Inflammatory bowel diseases such as ulcerative colitis, syphilis, tuberculosis etc.

3.            Posterior angulation of anal canal.

4.            Relative fixation of anal canal posteriorly.

5.            Elliptical shape of anal canal.

6.            Previous anal surgery- when too much skin has been removed during surgery and anal stenosis has occurred.

7.            Parturition.

8.            Persons taking laxatives or purgatives for long.

9.            Trauma by nozzle of enema, speculums.

Clinical Features

1.            Pain

                Acute anal pain is associated with the passage of stool. The pain starts with act of defecation and is described as sharp cutting or tearing which continues as abusing discomfort for several hours following stool.

2.            Bleeding

                Usually slight but occasionally more profuse and may cause anaemia.

3.            Swelling as sentinel tag

                A tag like swelling called sentinel tag is formed due to low grade infection and oedema.

4.            Discharge and pruritis

                If there is much discharge, it increase the moisture of perianal skin with resulting pruritis around the anus.

5.            Nervous manifestation

                There may be abdominal discomfort, digestive disturbance, headache, irritability and extreme nervousness and there may be marked changes in the personality.

Complications

•             Abscess

•             Fistula in Ano

•             Hypertrophied papilla

•             Anal contracture

Treatment:

Preventive

1.            More fibre rich diet

                Increase intake of whole wheat flour, whole grain, brown rice, barley, legumes, green leafy vegetables.

2.            Liquids

                Increase daily liquid consumption in form of water, soup, milk, butter milk, juice etc.

3.            Proper anal hygiene should be maintained.

4.            Hot water fomentation or sitz bath of the anal region should be done.

5.            Alternative medicines for anal fissure lubrication can be done with olive oil, coconut oil which will lubricate the bowel system allowing the stool to pass easily.

Conservative Treatment of Anal Fissure with Ayurveda

Amla

It is the Indian gooseberry fruit that is highly rich in vitamin C and anti oxidants. It provides benefit in treating various conditions. It is highly helpful in curing anal fissures & constipation. It can be taken in form of juices & churnas.

Flax seed

It contains fibre and omega-3 fatty acids that reduce the risk of constipation effectively. It can be taken in powdered form with water.

Triphala Churna

It contains amla, haritaki & vibhitak. Triphala has many health benefits. It reduces body weight , provides relief from constipation, reduces inflammation, prevents viral and bacterial infections. 1 teaspoon or 5 gm of triphala churna with warm water can be taken before going to bed.

Isabgol

It is also known as psyllum and is obtained from seeds of plantago which is rich in dietary fiber. It is helpful in curing fissures effectively.

Rasaunt

It improves digestion, causes regular defecation and treats and heals ruptured vessels and cuts in anal passage.

Shallaki

It has pain relieving and anti-inflammatory action. It is useful in treating fissure pain.

Aloe Vera

It is the best home remedy for piles, fissures and fistula. If applied on anal fissures in the form of gel, it can give instant relief from itching and burning sensation in anal region. It can be taken in the form of juice to relieve constipation.

Bees Wax

Beas wax has been used as an antiseptic in wound healing. It is very effective in the healing of anal fissures when combined with honey and olive oil. This mixtures has anti bacterial properties.

Jati

It is a flowering plant, has antifungal and antibacterial properties against certain infections which hinder the healing process of ulcer and wounds. Thus, ayurvedic preperations made by jati or jasmine are very helpful in all types of chronic ulcers of fissures.

Kshar Sutra Application

The kshar sutra is tied at the base of sentinal tags by an ayurvedic surgeon. This cauterizes the tags and gradually eliminates the sentinel tag.

Basti Karma

It is the local treatment. Basties are prepared in ghrita, tail and milk with  addition of other herbs. Such medicated ghrita or tail is introduced into anal canal daily for 7- 10 days (15-20 ml) before going to bed. Examples are Jatayadi tail, Jatyadi ghrit, Kasisadi tail etc.

Anal dilators

The use of anal dilators of varying size is helpful. The anal dilator is lubricated and gently inserted into anal canal once a day after daefecation followed by hot sitz bath.

Commonly used Ayurvedic formulation are Abhyarishta, Hingwashtak churna, Chitrakadi vati, Rasanjan Vati, Triphala churna, Erand Bhrisht haritaki.

It can be concluded that fissures can be cured conservatively by taking ayurvedic drugs and adopting strict life style required in fissure patients.

Anal fissures cause a sharp pain that starts with the passage of stool. So, many patients try not to have bowel movement to prevent pain.

 

Foremost management of Anal fissure is include fiber rich diet to make stools soft and bulky.

 

Isabgol is widely known for its laxative and stool bulking abilities due to its gel forming properties in the presence of water.

 

Anal fissures can be prevented by avoiding straining during defecation,  prolonged diarrhoea & wetness around the anus.