Anal fissure

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Anal fissure is a painful wound in the skin just inside the bottom canal (anus). It is usually caused by passage of hard stool. The most typical complaint caused by anal fissure is pain.  Pain may be excruciating, it usually follows defecation or occurs later. People with anal fissure postpone defecation because they anticipate pain. Patients often describe glasses coming through their bottom during stool elimination.  Acute pain causes spasm (contraction) of sphincters (circular muscles around anus) and then spasm prevents healing of the crack. Pain equals spasm equals fissure. Constant spasm may cause tightening of the bottom canal..

Constant pain which is unrelated to defecation may be due to thrombosed hemorrhoids or inflammation (anal abscess). Superficial skin cracks (fissures) may be caused by excessive cleansing of perianal skin with toilet paper and soaps. Superficial fissures heal easily with proper hygiene. Fissures may be seen also in Crohn’s disease, syphilis, anal cancer or other diseases.

Pain in recent (acute) fissures is not so severe. Acute fissures do not require surgery. They bleed more often than long-lasting (chronic) fissures. Proper skin care, creams and soft stools may heal acute fissures. Stools may be made soft, drinking a lot of water, a diet rich in fibers and stool softeners.  After defecation, the anus should be cleaned with lukewarm water and no soap should be used. Warm (not hot) water relaxes sphincters and helps fissures to heal., On the contrary ,cold water (ice cubes) causes sphincter contraction and exacerbates pain.

Painful anal fissure requires an intervention in order to heal. This is obvious if finger examination of the anus is impossible. If treatment with local applications fails within six months or if the fissure reappears, then an intervention might be required. Any attempt to treat chronic (old) fissure requires relaxation of sphincter (perianal muscle) contraction. There are a lot of muscle relaxant creams or injections that help spasm relief and healing of fissure. If local treatments fail, laser or surgical intervention needs to be done. Laser is an innovative method that has not been used widely in Europe. There are already some positive reports from Asia or Greece. Most often a muscle relaxant procedure should be added to laser treatment.  The muscle relaxant procedures have excellent results. In Europe and USA, the surgical procedure currently applied for chronic anal fissure is lateral anal sphincterotomy. During these procedure, the lower third of internal anal sphincter is divided through a small 5 mm incision. Internal anal sphincter is of lesser significance in the contraction of sphincters. its partial division (sphincterotomy) rarely causes a mild incontinence to gas, especially In women.