Anal Fissures: A small tear in the thin moist mucosal lining of the anal canal, which is usually produced by the passage of hard stools is known as an anal fissure. It is linear or oval-shaped starting just below the dentate line extending to the anal verge.
Signs and Symptoms
- Sharp excruciating pain in the anal canal while passing stools is the cardinal feature of anal fissure.
- There will have a visible tear in the skin around the anus
- A small lump of skin called a skin tag near the tear
- Streaks of fresh blood on the stools or toilet paper
- An itching or burning sensation is felt near the anal region.
The main cause for the occurrence of an anal fissure is the passage of large and hard stools. The other causes include,
- Chronic constipation or diarrhea
- Straining at the time of delivery
- Irritable bowel disease or Crohn’s disease
- Tight or spastic anal sphincter muscles.
- An anal fissure is seen in diseases like tuberculosis, HIV, anal cancer, etc.
The exact pathophysiology for the development of anal fissure is not known. It is probably due to the acute injury which causes the spasm of sphincter muscles which results in the high anal sphincter muscles leading to ischemia and reduced healing.
The diagnosis can be done by an anorectal examination. The tear is visible by inspection. The acute one looks like a fresh tear. The chronic anal fissures likely have a deeper tear associated with internal or external fleshy growths. A fissure is said to be chronic if it is more than eight weeks old.
An anal fissure usually heals on its own in about six weeks. But care should be taken to have loose bowels because passing hard stools leads to repeated injury. Dietary fibers and stool softeners can be used. Soothing creams can be applied locally. Hip bath also advised in lukewarm water. Laxatives and analgesics are also used. In severe conditions, sphincterotomy is done.
In about 1 to 6% of cases, there is a chance of recurrence after sphincterotomy. In acute cases, it usually heals on its own.
A chronic anal fissure that fails to heal is the usually seen complication. A Sentinel pile is scar tissue at the site of the fissure. A permanent skin tag can result and fistulas may form.
Disease and Ayurveda
The anal fissure is described as Parikarthika.
Parikarthika can be caused due to endogenous factors like Seeta (cold), dry astringent food, less water intake, forceful holding of natural urges, night awakening, etc. The other reasons like trauma or in association with other diseases like Grahani, hemorrhoids. Due to faulty procedures like Virechana (purgation), vasthi (enema) also Parikarthika occurs.
Lakshana Signs and Symptoms
In Parikarthika the patient experiences severe pain in Guda (anus) as if cut by scissors. Sharp cutting and burning pain are said to the cardinal feature of parikarthika due to improperly done Vamana or Virechana. There will be a streak of blood in the stool.
It is treated by medicines and symptomatically patients get relief well. But indulgence of nidana (causes) can trigger its relapse.
Ayurveda describes only conservative management, no surgical management is said in any classical texts. The drugs which make stool soft are used. Local treatments like infiltration with murivenna, sitz bath with a decoction of Triphala or Nalpamara. Picchavasti and anuvasana vasthi can be advised.
Commonly used Ayurvedic medicines uk
- Mild purgative drugs like Hridya virechana
- Anulomana and deepana drugs like Gandharvahastadi kashaya with Gandarvaeranda
- Murivenna for anal infiltration
- Matravasthi with pippalyadi anuvasana thaila
- Anuloma DS tablets for constipation
- Aryavaidyasala Kottakkal
- Vaidyaratnam Oushadasala
Home Remedies and Diet
- High fibrous food
- Fruits like papaya, banana, grapes, etc.
- Abundant intake of water
- Sitz bath in lukewarm water
- Avoid hot, spicy, and dry food
Anal Fissures: Yoga postures that aid digestion and maintain proper bowel movements like Vajrasana, Padmasana, Pavanamukthasana, Mulabandhasana, Sishuasana, Padahasthasana, etc. are good.
Research articles link.