Sushruta Clinic - Fissure in Ano

It is most common disease 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 defecation which persists for some hours after act is over. Children and elderly persons are less commonly affected of the disease.

Causes :-

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 defecation which persists for some hours after defecation . 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 masspromotes the rupture of anal skin.

A streak of blood with faecal column may be seen. Some time mild to moderate bleeding may occur.

Swelling :-

In chronic anal fissure the ruptured skin becomes oedematus and forms a skin tag at the base of fissure most commonly at 6.0 clock.

Discharge :-

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.

Treatment :-

Mild aperient is taken at bed time in the night to soften the stool and pass out easily. Hot-sitz bath morning & evening after defecation is very helpful in relieving the pain which occurs after defecation.

Diet :-

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 recurrence are common problems after operations for anal fissure. Majority of the patients are dissatisfied with these types of modern operations.

Kshar Sutra Ayurvedic treatment of Anal fissure :-

The treatment of Anal fissure consists of hot-sitz bath twice daily morning and evening after defecation. Medicated oil enema is given twice daily before defecation and mild laxative like panchsakar churan One T.S.F. at bed time is given to remove the constipation. In spite of these treatment if the pain is persistent in chronic, non healing, infected fissure Kshar Sutra ligation is done under local anesthesia. 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 center with excellent cure rate.