Question 1

What is Anal Fissure?

Accepted Answer

An Anal Fissure, also known as Fissure-in-Ano, is a small tear or cut in the thin skin lining the external opening of the anal canal.

Question 2

What are the common causes of Anal Fissure?

Accepted Answer

Passing Hard Stools.Passing large amount of stool suddenly.Persistent watery stools or diarrhea.During childbirth.Anal Intercourse.Inflammatory Bowel Disease like Chron’s Disease.Syphilis.Tuberculosis.HIV.Anal Cancer.

Question 3

What are the Risk Factors of Anal Fissure?

Accepted Answer

Injury to the anal mucosa can happen when:You pass a large and hard stoolYou are constipated and try to pass a hard stoolYou have repeated diarrheaYou gave birth (childbirth can cause trauma to anal canal)Any foreign body entering into the anal canalIn some cases, due to Crohn’s disease

Question 4

What are the Types of Anal Fissure?

Accepted Answer

Anal Fissure are usually of Two Types:Acute Anal Fissure: Anal Fissures of Recent Onset.Chronic Anal Fissure: Anal Fissures lasting for more than 8 to 12 weeks.

Question 5

What are the Symptoms of Anal Fissure?

Accepted Answer

Symptoms of anal fissure may include:Pain, sometime severe, during bowel movement.Burning or Itching sensation in the anal canal.You may see a small spot of bright red blood on toilet paper or a few drops in the toiled bowel.A visible crack in the skin around the anus.A small lump or skin tag on the skin near the anal fissure.

Question 6

What are the Signs of Anal Fissure?

Accepted Answer

Looking at the fissure by gently separating the buttocks.A digital rectal examination, in which the doctor inserts a gloved finger into the anal canal.Initially, a fissure is just a tear in the anal mucosa and is defined as an acute anal fissure. If the fissure persist over time, it progresses to chronic fissure, and often, an enlarged anal skin tag is present in the anal canal proximal to the fissure and hypertrophied anal papillae are present in anal canal proximal to fissure.Most anal fissures occur in the posterior midline, with remainder occurring in the anterior midline. About 2% of the patients have anterior and posterior fissures.Fissures occurring off the midline should raise the possibility of other bowel conditions (for example Crohn's disease), infection (for example sexually transmitted diseases or AIDS), or cancer.Anoscopy: This involves using a short, lighted scope to look into the canal.

Question 7

What are the Treatment Options for Anal Fissure?

Accepted Answer

Majority of the Anal Fissures will not need any surgical treatment.Lifestyle modifications like High Fibre Diet, Stool Softeners, Increasing water intake to promote soft bowel movements, Warm Sitz Bath, Local application of appropriate ointments will usually promote the healing of the Anal Fissure.Chronic Anal Fissures and very rarely certain Acute Anal Fissures not responding to medical therapy, will need Surgical Treatment.

Question 8

What are the Medical Treatment for Anal Fissure?

Accepted Answer

First line of treatment consists of therapy with stool-bulking agents, such as fiber supplementation and stool softeners. Laxatives are used as needed. Mineral oil may be added to facilitate the passage of stool. Sitz baths after bowel movements and as needed to provide significant symptomatic relief.Second line medical therapy consists of intra-anal application of 0.4% nitroglycerin (NTG; also called glycerol trinitrate) ointment directly to internal sphincter.

Question 9

What are the Surgical Treatment for Anal Fissure?

Accepted Answer

The most commonly performed surgery is a Lateral Internal Sphincterotomy.Certain Chronic Fissure which may not heal completely with a Lateral Sphincterotomy, will need an Excision of the Fissure with cover of the defect by an Advancement Flap.Lasers can be also used as a modality in the treatment of Anal Fissure.

Question 10

What Post Operative Care is required after Anal Fissure Surgery?

Accepted Answer

Try to avoid constipationInclude fruit, vegetables, beans, and whole grains in your diet every day. These foods are higher in fiber.Drink plenty of fluids.Get some exercise every day.Take a fiber supplement, every day if needed.Do not strain when you have bowel movement and do not sit on toilet too long.Take Sitz baths 2 to 3 three times every day.Instead of using toilet paper, use baby wipes or medicated pads.

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