What is an anal fissure?
The word fissure means a cut or a gap. Anal fissure is a cut at the anal opening.
Causes
When a patient is constipated the stools become hard like a stone. When these hard stools are being passed through the anal opening, they injure the skin of the anus & produce a tear there.
Symptons
PAIN is the most prominent symptom of anal fissure. It becomes excruciating during the act of passing stools and persists for 1-2 hr. after the act is over. Some patients are so afraid of this pain that they prefer to remain constipated rather than to try and pass stools. A few drops of blood may be noted along with the stools.
Treatment
95% of the patients do not require an operation. They are advised to follow the following steps for 3- 4 weeks.
- Anesthetic jelly (LIGNOCAINE) is applied to the fissure about 10 minutes prior to defecation. This jelly benumbs the area completely and the act of defecation becomes totally painless.
- Two points need to be stressed in application of the ointment:
- The timing of application is very important.
- The ointment should be applied with the nozzle fully inserted in the rectum and NOT with the finger.
- After the defecation is over we ask the patient to squat in a tub of lukewarm water for 10-15mins. This gives fomentation to the affected area and hastens the healing. This should be done after every bowel movement.
- Avoid constipation- a liquid laxative and husk of isapghula should be taken at bedtime.
When is operation necessary?
- When a fissure is recurring very often.
- If patient does not get relief after few days of treatment as suggested above.
The operation is always performed under general anaesthesia. It is quite simple and the duration of hospital stay is 1-2 days.
Since the underlying cause of a fissure is hard stools, an operation DOES NOT GUARANTEE that fissure will not occur again.
Prevention
Avoid constipation
- Take plenty of vegetables and fruits in your diet.
- Regular physical exercise.
- Drink plenty of liquids.
- Stop smoking, chewing pan & tobacco, consuming strong tea, coffee & alcohol.
- Excessive worry & anxiety is known to cause constipation. Avoid it as much as possible.
Q. What is a fistula ?
A. A fistula is an abnormal tunnel connecting the body cavity and the external surface. Anal fistula connects the lumen of the rectum or anal canal with the perianal skin.
Q. What causes anal fistula ?
- In almost all cases it is the end result of a perianal abscess.
- A chronic anal fissure can give rise to anal fistula.
- Rarely fistula may be secondary to the inflammatory disease of the colon.
- Some fistulas are caused by cancer in rectum. This is the reason why every fistula should be promptly examined by an expert.
Q. Are all fistulas a like ?
A. No – fistulas are classified into “low” and “high” depending on the level of their internal opening, as related to the anal sphincter. The high fistulas are more difficult to cure. Some fistulas may have branched tracts and multiple openings.
Q. What are the symptoms of anal fistula?
A. The commonest symptom of anal fistula is a discharge of pus and bloody fluid from the external opening. Sometimes the external opening gets blocked; this increases the pressure inside the fistula and causes intense and throbbing pain.
Itching is common due to constant wetting of the skin locally.
These symptoms may be episodic in nature, but the fistula never heals without surgical treatment.
Q. What is the treatment of anal fistula?
A. Surgery is the only permanent treatment o anal fistula.
Operation for low fistula is very simple and the patient is usually sent home after 2 – 3 days. High fistula can be quite difficult to cure and may require 2 – 3 operations.
Q. What is the after-care after the operation of anal fistula ?
A. As the wound is not stitched, but kept open to heal, dressings are required twice a day. The patient sits in a tub of warm water after every bowel movement to cleanse the area of operation. The pain of operation lasts for 48 hours after which the patient resumes normal activity. On an average the patient can resume his work after 2 – 3 weeks.
There is great fear in the minds of patients that operation for anal fistula may lead to loss of control in that region. In a properly done operation this fear is totally groundless. An operation for anal fistula is no guarantee that a fistula may not form in some other area.
Piles mean enlargement and congestion of the veins in the inner lining of the anal canal. Constipation and straining at the stool are the most important factors which aggravate the piles and cause an ‘attack’. An ‘attack of piles’ is a very common complaint which we see in our surgical practice. The patient complains of bleeding at the time of defaecation. This bleeding is typically painless and occurs towards the end of defaecation. The blood is bright red in colour and may either spurt in the bowl or fall down drop by drop.
When the piles become chronic the piles which are deep inside the rectum begin to enlarge and start coming out of the anal opening. They may go back on their own or may have to be pushed inside with a finger at the end of defaecation. In patients above the age of 45, before starting any treatment for piles it is very important to do a test called ‘Sigmoidoscopy’. This test ensures that there is no ulcer or tumour higher up in the intestine which may be the real cause of bleeding. To treat such a patient for piles and miss a tumour higher up could be disastrous for the patient.
Piles in the early stages do not require an operation. They can be managed by the following regimen :
To avoid constipation
- Do not eat excessively spicy and oily food.
- Take plenty of vegetables, salads and fruits in your diet.
- Drink plenty of fluids – > 3 liters.
- Take regular moderate exercise (Yogasanas, brisk walks etc.)
- Do not become overweight.
- Stop smoking, chewing paan and tobacco, consuming strong tea, coffee and alcohol.
- Excessive worry and anxiety is known to cause constipation.
* After passing stools squat in a tub of warm water to give fomentation to the affected area. This helps in reducing the swelling.
* To reduce the swelling further, we prescribe an ointment to be applied locally, 2 -3 times a day. The ointment should be applied with a nozzle which is supplied along with the tube because the finger cannot reach the piles deep inside the rectum.
* To avoid hard stools, laxatives may be prescribed.
Piles in the early stages can also be effectively controlled by giving an injection of 5 percent phenol with oil in the pile mass. This injection is totally painless and does not have to be repeated in most of the cases.
Operation is required in the following situations
- Piles which have become so enlarged that they have to be pushed back manually.
- Piles which are not responding to the simple measures prescribed above.
- Piles which have come down and have become swollen and painful.
There is NO danger of losing control over the sphincter after the operation. There is no unbearable pain after the operation. The patient is hospitalized for 2 -3 days and can start work after the total period of 2 -3 weeks. After the operation secondary piles may develop after many years if the patient remains constipated and continues to strain at the stool.
Perianal abscess
