An anal fissure or rectal fissure is a break or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on toilet paper and under garment sometimes in the toilet. If acute they may cause pain after defecation (passing stool) but with chronic fissures pain intensity is often less. Anal fissures usually extend from the anal opening and are usually located posteriorly in the midline, probably because of the relatively unsupported nature and poor perfusion of the anal wall in that location. Fissure depth may be superficial or sometimes down to the underlying sphincter muscle.

Causes –Most anal fissures are caused by stretching of the anal mucosa beyond its capability. Superficial or shallow anal fissures look much like a paper cut, and may be hard to detect upon visual inspection, they will generally self-heal within a couple of weeks. However, some anal fissures become chronic and deep and will not heal.

The most common cause of non-healing is spasming of the internal anal sphincter muscle which results in impaired blood supply to the anal mucosa. The result is a non-healing ulcer, which may become infected by fecal bacteria. In adults, fissures may be caused by constipation, the passing of large, hard stools, or by prolonged diarrhea. In older adults, anal fissures may be caused by decreased blood flow to the area. When fissures are found laterally, tuberculosis, occult abscesses, leukemic infiltrates, carcinoma, acquired immunodeficiency syndrome (AIDS) or inflammatory bowel disease should be considered as causes. Some sexually transmitted infections like syphilis, herpes, Chlamydia and human papilloma virus can promote the breakdown of tissue resulting in a fissure.
Other common causes of anal fissures include:

  • childbirth trauma in women
  • Sexual Activities
  • Crohn’s disease
  • ulcerative colitis
  • Poor toileting in young children.

Prevention — For adults, the following may help prevent anal fissures:

  • Avoiding straining when defecating. This includes treating and preventing constipation by eating food rich in dietary fiber, drinking enough water, occasional use of a stool softener, and avoiding constipating agents. Similarly, prompt treatment of diarrhea may reduce anal strain.
  • Careful anal hygiene after defecation, including using soft toilet paper and cleaning with water, plus the use of sanitary wipes.
  • In cases of pre-existing or suspected fissure, use of a lubricating ointment (It is important to note that hemorrhoid ointment is contraindicated because it constricts small blood vessels, thus causes a decrease in blood flow, which prevents healing.)

In infants, frequent diaper change can prevent anal fissure. As constipation can be a cause, making sure the infant is drinking enough fluids (i.e. breastmilk,). In infants, once an anal fissure has occurred, addressing underlying causes is usually enough to ensure healing occurs.

Treatment –Non-surgical treatments are recommended initially for acute and chronic anal fissures. These include medications like – topical nitroglycerin or calcium channel blockers (e.g. diltiazem), or injection of botulinum toxin into the anal sphincter.

  • Other measures include warm sitz baths, topical anesthetics, and high-fiber diet and stool softeners.
  • Surgery – Lateral internal sphincterotomy
  • Anal dilation.

Homoeopathic treatment –There are so many medicines available for anal fissures in homoeopathy, but for proper healing of fissures one must consult homoeopathic physician for accurate selection of medicine according to person’s individTuality. Few medicines which are ranked high in curing fissures are given below. But proper case taking of patient must be done.

  • Nitric Acid — for anal fissures with bleeding after stool. There is splinter like pain in the anal or rectal region. It feels as if some splinter has lodged in the area. Another feeling is as if the rectum is torn. There is offensive discharge from the fissure. This offensiveness of discharges may even extend to the urine, stool and even perspiration. The patient is prone to take colds. If patient is experiencing stitching and tearing pains in the anus, or the pain is cutting or stinging in nature, Nitric Acid is the perfect remedy. Since the stool passed is hard, and is accompanied by bright red bleeding from the anus, Nitric Acid is the best Homeopathic remedy. Diarrhea is also frequently present. The stool is quite soft. Despite the stool being soft, one has to strain to pass the stool.
  • Graphites — for anal fissure with burning. The patient is usually obese or overweight. Constipation is another prominent symptom of this medicine for anal fissures. The stool may be hard, large, and knotty and joined by mucous threads. There may be other skin symptoms like eczema which is characterized by oozing of thick sticky fluid. The patient is usually chilly and cannot tolerate cold air or cold weather. It is also indicated when anal fissures occur in women around or just after menopause.
  • Ratanhia — for anal fissures with pain that lasts for hours after passing stool. There is a feeling of constriction in the rectum. The pain is burning in nature. There may also be a feeling as if the rectum is full of broken glass. The pain may be temporarily relieved by cold water.
  • Paeonia — for anal fissures with constant moist oozing. There is oozing of offensive moisture. There is a strange feeling of internal chilliness in the rectal region. The anal region seems to be covered with crusts. Diarrhea is more likely to occur in this medicine rather than constipation.
  • Phosphorus — for anal fissures with painlessness. When there is little pain despite the presence of anal fissure, Phosphorus is one of the best medicines for anal fissures. The patient is usually tall, thin and narrow chested. There is increased thirst for icy cold water. The patient is unable to tolerate warm water and as soon as the water turns warm in the stomach, it is vomited. This medicine is known to irritate, inflame and cause degeneration of the mucous membranes all over the body. The stool is long, narrow and hard, like that of a dog. The stool may be white and hard too. The patient is very sensitive to light, sound and all sorts of external impressions.
  • Sulphur — for Anal Fissure pains. The stool is hard and dry, causing tears and immense pain in the anus while passage. The patient is fearful of even going to the toilet as he thinks of the pain that will accompany the passage of stool. Sulphur is of great help in reducing the pain and softening the stool. The pain is almost always accompanied by burning. Itching in anus due to fissures is best controlled with the use of Sulphur.
  • Bryonia, Alumina and Natrum Mur — for relieving Anal Fissure constipation. Homeopathic medicine Bryonia can be used in all cases where the stool is very hard, dry and large, leading to Anal Fissures. Bryonia will help in softening the stool and thereby preventing the tears in the anus that occur due to hard stool. Homeopathic medicine Alumina is mainly given when constipation is of the worst kind. The stool remains in the rectum for very long. The stool is hard and dry less than bryonia and knotty and passes with difficulty, causing cracks and bleeding from the anus. Homeopathic medicine Natrum Mur provides help when the stool is hard and dry. Stool breaks frequently while passing due to constriction of anus. Bleeding and pain of burning, smarting and stitching nature follow the passage of stool.

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