A small tear in the moist, thin tissue that lines the anus is called an anal fissure. The muscular opening at the end of the digestive tract where stools leave the body is called the anus. Constipation and straining or passing large or hard stools during a bowel movement are two common causes of an anal fissure. With bowel movements, anal fissures typically cause pain and bleeding. Spasms in the anal sphincter—a ring of muscle at the end of your anus—may also occur.

Anal fissures can occur at any age, but they are most common in young infants. The majority of anal fissures improve with simple treatments like eating more fiber or taking a warm water bath. Anal fissure patients may require medication or, in rare cases, surgery.

Q.What is fissure (फिशर)

Ans: An anal fissure is a small cut or tear in the tissue of anal opening. Fissure in ano is observed in all age group but it is more common in middle aged adults. The posterior midline of anus is the most common site for fissure due to low blood supply in this area. Anal fissure can be diveded into primary and secondary anal fissures based on etiology; Posterior and anterior fissures based on location and acute and chronic anal fissures based on the duration of symptoms.

• Claasified into two subtypes according to causative factors (Etiology):-

1. Primary anal fissure- caused due to local trauma such as hard stools, prolonged diarrhea, vaginal delivery, repetitive injury or penetration. These are usually posterior and anterior in location.
2. Secondary anal fissure- caused due to previous surgical procedures in anal area, inflammatory bowel disease, tuberculosis, sarcoidosis, HIV/AIDS, syphilis, they are usually multiple and lateral in position.

• Anal fissure may be classified into several types based on location:-

1. Posterior anal fissures- it is most common found in 90% cases, it lies at 6 o’clock position when patient examined in lithotomy position.
2. Anterior anal fissures- it is second commonest fissure found in 10% cases, it lies at 12 o’clock position when patient examined in lithotomy position.
3. Lateral anal fissure- lateral fissure is less common causative factors are secondary like previous surgical procedures in anal area, inflammatory bowel disease, tuberculosis, sarcoidosis, HIV/AIDS, syphilis.

• Based on duration of symptoms, an anal fissure may be classified as either acute or chronic fissure.

1. Acute anal fissure- an acute fissure looks like a fresh tear somewhat like a paper cut. It of lesser duration i.e. 4 weeks.
2. Chronic anal fissure- typically occurs in the midline with visible sphincter fibers at the fissure base, anal papillae, sentinel piles and indurate margins. In chronic fissure there is cycles of pain and recovery for several times.

Q. What are the symptoms of fissure?

Ans: If person having one or more of the following symptoms he maybe be suffering from fissure :-
• Pain While making bowel movement there sharp pain like knife cut.
• Itching in anal region. • Discomfort while sitting .
• Bleeding while passing stool, it is not there in all patient. Blood is noticed on stool surface like a strip or post defecation there is bleeding sometime noticed on toilet paper while cleaning.

Q. What are the causes of fissue?

Ans: Most common cause is CONSTIPATION. Chronic constipation due to any reason (such as habitual, drug induced , irregular meals or irregular bowels habits) leads to recurring abrasion or forcefully rubbing of anal mucosa which leads to fissure. Other causes – chronic diarrhea, multiple pregnencies, chronoic use of laxatives, or any surgical procedure performed in anal canal may cause fissure.

Q. What one should do to prevent fissure?

Ans: One should take following measures to prevent fissure. Eat balance diet :- Passing large, hard, or dry feces might create an anal fissure if you are constipated. Constipation can be avoided by having a balanced diet that includes fruits and vegetables. Also, do not cut out all fat from your diet; fat and oil are good lubricants that keep your digestive system running smoothly. Remember to drink sufficient water to keep yourself hydrated. Exercise :-Lack of physical activity can cause constipation. To keep your digestive system working and in good shape, exercise for at least 30 minutes each day. Aim for 150 minutes each week or more. Don't ignore your need to go:-If your body tells you that it is time for a bowel movement, don't put it off. Waiting too long or too often causes these signals to weaken. The longer you keep it in, the dryer and harder it becomes, making it more difficult to pass. Follow healthy bowel habits:-You can ease constipation and pressure on the anal canal with these suggestions. Follow these methods regularly to reduce your chances of developing a painful anal fissure:
• Allow ample time to pass bowel movements comfortably when using the restroom. However, don't stay on the commode for too long.
• When passing stools, don't strain.
• Keep the anal region dry.
• After each bowel movement, gently clean yourself.
• If you are suffering from persistent diarrhea, seek medical help.

Q. How fissure is diagnosed?

Ans: diagnosis will include medical history and local examination by your doctor.

Q. What are the Treatment options available for fissure?

Ans: Acute fissure ( fissure of less duration ~ 1 month old ) can be cured by medication and modified of diet. But if fissure is chronic I.e. more older then surgery like fissurectomy or lateral sphincterectomy are performed in allopathy. Some doctor perform lord’s dilatation (anal stretch to paralize anal sphincter muscles temporarily) or locally botox injection are given. In all these procedure patient require bedrest, hopitalization, spinal or general anaesthesia and lot of medication. At Arogyam piles clinic and research centre most of the fissure patinet are manged with ayurvedic medicine and diet modification but in some chronic fissure patient we perform non surgical procedure for the Treatment of chronic fissure I.e. ksharkarma. In this procedure medicinal plants extract -alkaline paste is applied on anal fissure and it heals simultaneously. No need of hospitalization, no need of spinal or general anaesthesia, no cut, no blood loss and patient can resume his routine activity from next day.

Q. If fissure left untreated what are complications

Ans: If fissure left untreated for longer time it get infected and for that major intervention required and some time untreated fissure lead to cancer. So consult your doctor as soon as possible.