Sushruta Clinic- Fissure in Ano
It is most common diasese of Anal Canal which commonly affects the young and adult persons between age group of 21-40 years. Fissure is a linear ulcer in
the mucocutaneous lining of lower anal canal. There is sharp cutting burning or tearing pain in anal canal during defaecation which persists for some hours
after act is over. Children and elderly persons are less commonly affected of the disease.
Constipation is the most common cause of anal fissure. In constipated patient during passage of hard faecal mass the cutaneous part of anal canal is liable to
rupture or teared resulting in acute anal fissure. Due to repeated trauma during passage of hard stool the fissure becomes chronic and healing is rejected.
Clinical feature :-
The chief symptom of anal fissure is sharp cutting, burning or tearing agonising pain during defaecation which persists for some hours after defaecation. The
pain is so severe that most of the patients are frightened to go to stool and remains constipated for several days. The constipation with hard faecal mass
promotes the repture of anal skin.
A streak of blood with faecal column may be seen. Some time mild to moderate bleeding may occur.
In chronic anal fissure the ruptured skin becomes oedematus and forms a skin tag at the base of fissure most commenly at 6.0 clock.
Chronic anal fissure becomes infected with pus discharge from anus, so there is a burning and itching at perianal region due to irritating pus discharge.
Mild aperient is taken at bed time in the night to soften the stool and pass out easily. Hot sitz bath morning & evening after defaecation is very helpful in
relieving the pain which occurs after defaecation.
Fatty, fast and fried food are avoided, saft palatable light and high fibrous diet is recommended. Two wheeler vehicles, scooter, Motor Cycle, Cycle are avoided
because these vehicles aggravate the anal fissure.
Operative Treatment :-
When all the attempts of medical treatment is failed, surgery is indicated in chronic repeated non healing, Septic or infected and fissure.
Generally 3 types of operations are performed in anal fissure.
1. Forcible four finger and dilatation.
2. Closed lateral sphincterotomy.
3. Open posterior sphincterotomy.
The operative results of anal fissure are not always satisfactory. Various forms of complications like rectal incontinence, faecal soiling of under clothes and
recorrences are common problems after operations for anal fissure. Majority of the patients are dissatisfied with these types of modern operations.
Ayurvedic treatment of Anal fissure :-
The treatment of Anal fissure consists of hotsitz bath twice daily morning and evening after defaecation. Medicated oil enema is given twice daily before
defaecation and mild laxative like panch skar chooron One T.S.F. at bed time is given to remove the constipation. Inspite of these treatment if the pain is
persistant in chronic, non healing, infected fissure Kshar Sutra ligation is done under local anaethesia. The results of Kshar sutra treatment in anal fissure is
excellent with high success rate of 98.0% . The post operative complications are nil. 500 cases of chronic non healing anal fissure have been treated by Kshar
Sutra during the year 2002 to Jan 2012 at this centre with excellent cure rate.