Anal Fissure Treatment in Indore

What is Anal Fissure?

An anal fissure is a small tear or crack in the sensitive skin that lines the anal canal, close to the anus opening. The tear is only a few millimeters long but can be out of proportion to the pain it causes since the lower anal canal is richly supplied with sensory nerves. The pain is often described as passing a blade or broken glass and can last minutes to hours after each bowel movement.
Fissures are common in young and middle-aged adults as well as in the infant and older people. Most are located in the midline posteriorly in the anal canal. A fissure on the side or more than one fissure indicates an underlying condition, and needs further attention.
The problem is often delayed by patients who are embarrassed to seek help and resort to repeated home remedies which only prolong the problem. Dr. Kriti Bansal Oza examines patients with anal complaints in a private and respectful setting and offers a stepwise approach which starts with simple measures. The treatment of anal fissure in Indore begins with a gentle examination and a simple step-by-step plan.

Acute and Chronic Fissure

Acute is a fissure that is less than six weeks old. It’s a new cut and the edges are clean . Most of these are healed with simple measures . A crack that lasts longer than six to eight weeks is considered chronic. Features include deeper tissue, with the white fibers of the internal anal sphincter muscle visible at its base, a thickened edge, a skin tag at the outer end (sentinel pile) and an enlarged papilla at the inner end Chronic fissures are less likely to heal with diet and ointments alone and may require medical or surgical intervention. Chronic fissure treatment in Indore can include ointments, botulinum toxin or a surgery if simple measures have failed.

Anal Fissure Symptoms

The pattern of symptoms is pretty typical.

• Sharp pain with bowel movements: You may have pain when you pass stool and this can last for several hours as a throbbing or burning ache.
• Bright red bleeding: A small amount of fresh blood is seen on tissue paper or on the surface of the stool and it rarely mixes with the stool.
• Anal spasm: The muscles around the anus contract involuntarily which increases the pain during stool passage.
• Itching and irritation: Mucus discharge and minor wetness can lead to localized itching.
• Skin tag or lump: In chronic cases a small swelling may develop at the edge of the tear.
• Fear of defecation: Patients may avoid going to the toilet which results in hard stools and aggravates the cycle.
• Difficulty or pain with urination: Sometimes pain radiates to the lower back or the urinary passage.

Bleeding from piles, polyps, inflammatory bowel disease and cancers can all look similar so new bleeding should be checked by a doctor, especially in older adults or when the bleeding is dark or mixed with stool.

The Causes of Anal Fissure

A fissure occurs when the lining of the anus is overstretched and doesn’t heal because of decreased blood flow and a muscle that remains tight.

• Constipation and hard stools: The most common cause is passing large, dry stools or straining.
• Chronic diarrhea: Repeated loose stools irritate the skin and can cause small tears.
• Tight internal anal sphincter: Increased resting pressure of the muscle compresses blood vessels in the anal wall, reducing blood supply and delaying healing.
• Low-fibre diet and low fluid intake: Hard stools are caused by eating processed foods, low intake of fruits and vegetables and insufficient water intake.
• Childbirth: The anal canal can be injured during delivery and cause a fissure in the weeks that follow.
• Anal intercourse or injury: Direct trauma can tear the lining.
• Underlying disease: Fissures may be caused by Crohn’s disease, tuberculosis, sexually transmitted infections, HIV and cancers; these are suspected when the tear is off-centre, without pain or does not heal.
• Prolonged sitting and reduced physical activity: This can lead to constipation and straining.

The Cycle That Keeps a Fissure From Healing

It’s easier to follow treatment if you know why a fissure is hanging around. Hard stool cuts the skin. The tear is painful, the sphincter muscle is spasming. The spasm reduces the blood flow to the already injured area and so the tear cannot heal. The patient holds the stool because of fear of pain, which makes it harder and larger, re-opening the tear with the next bowel movement. Treatment is aimed at breaking this cycle, by softening the stool, relaxing the muscle and improving blood flow.

How Anal Fissure Is Diagnosed

From the history and by gently looking the doctor can usually diagnose a fissure. The tear is often seen when the buttocks are gently parted and the digital rectal exam may be deferred if it is too painful or done after applying a local anesthetic gel. Proctoscopy or sigmoidoscopy can be deferred until fissure heals.

If the fissure is in an unusual location, if there is blood mixed in the stool, if diarrhea or weight loss is present, if the patient is above 45 years or if the fissure does not heal despite proper treatment, a colonoscopy or further tests are suggested. This helps to exclude inflammatory bowel disease, infections or tumors.

Treatment of Anal Fissure

Treatment moves from simple to more specialized measures and many people are cured at the first step.

Self-care and diet

Increase the intake of fiber and include vegetables, fruits, oats, whole grains, pulses and isabgol husk in your diet. Drink at least two to three liters of fluid every day unless otherwise advised. If necessary, take a stool softener such as lactulose or polyethylene glycol. Don’t overdo it and don’t sit on the toilet too long. Clean gently after passing stool with water instead of rough paper.

Warm Sitz Bath

To relax the sphincter and relieve pain and increase blood flow sit in warm water for 10 to 15 minutes two or three times a day and especially after bowel movements.

Ointments with medication

Local muscle relaxants like diltiazem 2% or glyceryl trinitrate 0.2% (nitroglycerin) are applied around the anal margin for six to eight weeks. They relax the internal sphincter and are helpful for healing. The choice is individualized, headache being caused by nitroglycerin and local irritation by diltiazem. Local anesthetic gels such as lidocaine can provide temporary relief and mild steroid creams can be applied for a short period of time for local inflammation.

Botulinum toxin injections

A small dose of botulinum toxin is injected into the sphincter in patients who do not tolerate or do not respond to ointments. It relaxes the muscle for about three months, allowing time for the fissure to heal, and does not carry the risk of long-term change in continence seen with some surgery.

Surgery

The most established surgical option for chronic fissures that persist despite medical treatment is lateral internal sphincterotomy, a short procedure in which a small portion of the internal sphincter muscle is cut. It heals most cracks and relieves pain rapidly . Slight risk of mild gas control problems . Advancement flap procedures are options in selected individuals with low sphincter pressure. After assessment the surgeon and gastroenterologist decide the best option.

Preventing Recurrence

A healed fissure can recur if the habits that caused the fissure are not changed. Eat a high fiber diet, drink plenty of fluids and respond quickly to the urge to go, don’t delay toilet visits, exercise regularly and limit foods that cause constipation. Treat diarrhea early and do not take laxatives for long periods without advice. Keep the area clean and dry. Do not use harsh soaps or perfumed wipes.

When to See a Doctor

If the pain lasts more than a week or two, or bleeding is heavy or repeated, if you notice a lump, discharge or fever, or if you have had a fissure that has reappeared, see a doctor. If you have a long-standing bowel disease, weight loss or a change in your usual bowel pattern, seek help earlier. A fissure doctor in Indore can examine can examine you privately and tell you whether the problem is an acute fissure, a chronic fissure or something else.

Anal Fissure in Infants, Children and Pregnancy

Cracks are common in infants, usually in the first year of life, and are often associated with constipation, a switch from breast milk to formula or solids, or episodes of diarrhea. Parents notice that the child cries when passing stool and see a streak of blood in the nappy. Most will heal with softer stools, more fluid intake, gentle cleaning and barrier creams. If a child has fissures that won’t go away a pediatrician should be consulted.

Fissures are more common with hormonal changes in pregnancy and after delivery, pressure on the pelvis and iron tablets and constipation. The cornerstones of management are fiber, fluids, stool softeners deemed appropriate in pregnancy by the treating physician and warm sitz baths, with medicated ointments being only used after suitability has been checked.

Fissure, Piles or Something Else?

People often assume that any bleeding from the anus is piles. But the thing is, the pain is the difference. A crack that causes a small amount of bright red blood and sharp pain during and after a bowel movement. Piles can bleed without pain. Piles may be a lump which comes out. Piles may cause itching or a feeling of fullness. Perianal abscess causes throbbing pain, swelling, and fever. An anal fistula is a draining tract that develops near the anus. Serious problems like rectal polyps or cancer can also bleed and are more likely to cause a change in bowel habit, mucus, dark blood or weight loss. A good examination ensures these conditions are not overlooked.

Using Ointments and Sitz Baths Correctly

Ointments only work if you use them right. Wash your hands and then apply a pea-sized amount of the medicine to the anal margin or, if the doctor advises, just inside the opening two or three times a day for the full period, even if the pain eases early. The most common cause of fissure recurring is stopping too soon. Use a clean basin or tub and warm, not hot, water for sitz baths. Sit for about ten minutes and then dry the area with a towel. Do not add antiseptics unless so advised. Keep up these routines, as well as dietary measures.

Fibre Guide for Soft Stools

• Milk thistle: One to two teaspoons in a glass of water daily plus more water throughout the day
• Fruits: Papaya, guava, pear, apple with skin, orange and prunes help in softening stools.
• Vegetables: Spinach, carrots, bottle gourd, beans, peas and salads provide bulk.
• Whole grains and pulses: Fiber is available in oats, whole wheat roti, brown rice, dal and rajma.
• Fluids: Water, buttermilk, coconut water and soups help to keep the stools soft.

Why Choose Dr. Kriti Bansal Oza

Dr. Kriti Bansal Oza treats patients personally and sensitively and explains the findings before initiating any treatment. This enables those who are shy about anal complaints to discuss their symptoms without hesitation.

She follows the stepwise approach so that no one is pushed into a procedure that may not be needed, while patients with chronic fissures are given a timely surgical referral. If the fissure is in an unusual position or does not heal she also looks for an underlying cause.

Patients looking for an anal fissure specialist in Indore will be given clear instructions on diet, ointment usage and follow up with a review to confirm that the fissure has healed.

Book a Consultation

Phone: +91-7610102710
Email: drkritigastro@gmail.com